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L1 – Balneology in 2020
Constantin MUNTEANU¹,², Diana Nicoleta MUNTEANU1,3, Gabriela DOGARU1,4
Corresponding author: Constantin MUNTEANU, E-mail: office@bioclima.ro
Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L1 OP Vol.11, No.3, September 2020 p: L1
1. Romanian Association of Balneology, Bucharest, Romania

2. Emergency Clinical Hospital „Bagdasar-Arseni”, Bucharest, Romania
3. National Institute of Rehabilitation, Physical Medicine and Balneology, Bucharest, Romania
4. “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, Clinical Rehabilitation Hospital Cluj-Napoca, Romania
Abstract
Introduction. The development of Balneary Tourism could be a real COUNTRY Project, because what can
be more complete from a socio-economic point of view than increasing the level of health and using the huge
balneary potential on which the existence of therapeutic natural resources and Spa Resorts have given them to
our country, as well as the financial potential that can result from this activity.
From our point of view, such a desideratum could be achieved only through a program - the financing axis
dedicated to Spas and Balneology, which aims at a Promotion of Romania in this regard, to allow the use of
natural therapeutic factors safely during post-pandemic and create the opportunity to increase our tourism
potential in this field through modern know-how and in an updated socio-economic context.
The demographic factors of modern society register phenomena such as the aging population and the
increasing incidence of diseases related to the generalization of the sedentary urban lifestyle. Spa tourism can
be an easy to implement alternative for restoring the health of the individual and to act prophylactically and
preventively to maintain an optimal functional balance of biological and psycho-social parameters of the
individual.
The use of thermal and mineral springs in the country for health and treatment purposes is a tradition with a
history of over two thousand years. The legend of Hercules, bathed in the waters of Cerna is proof of the use
of thermal waters long before the conquest of the Romans. This tradition exists in almost all civilizations.
Today it maintains its utility and is spread on all continents, mainly in the Middle East and Southeast Europe,
Asia (Middle East, Japan, China, Turkey), South America (Argentina, Mexico, Colombia), and North Africa
( Morocco, Tunisia).
Ensuring measures and rules that respond to the fear of one's safety will be a harder element to overcome
without an effective promotion and funding program and the judicious use of European funds. Thus, we can
create levers that greatly increase the level of addressing spa tourism, both domestically and internationally.
On the other hand, we contribute through editorial publications and the Balneo Research Journal to the
promotion of spa tourism in the country and internationally. But, the elaboration and implementation of such
a program - the financing axis dedicated to the Spa Resorts would also have the motivation to generate new
scientific data that would increase the possibility of promoting the concept of Spa Romania.
We know that, after this pandemic episode, tourism will start, sooner or later, for all countries in the world.
After this global re-start, we have a unique chance to reduce the gap in attracting tourists and tourists to spas.
However, this must be thoroughly prepared, planned, and properly implemented.
We are convinced that other substantial arguments can be made to put spa tourism back in "pole position", if
we give priority to scientific research, without which the foundation will be much weaker. This would be a
time for reflection on the key role of scientific research in promoting spa tourism. The huge potential cannot
be exploited without scientific research and efficient promotion on a globalized tourism market and with
outstanding competitors.
L1
L2 - Efficacy of Balneoclimatology on the Increase
in Functionality and Quality of Life in Persons with Parkinson’s Disease
Gabriela DOGARU¹, Ioana STANESCU¹, Adriana BULBOACĂ¹, Marieta MOTRICALA²

Corresponding author: Gabriela DOGARU, E-mail: dogarugabrielaumf@gmail.com
1. “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, Clinical Rehabilitation Hospital Cluj-Napoca, Romania
2. S.C. Baile Tusnad, Romania
Abstract
Introduction. Pain, gait and balance disorders in Parkinson’s disease represent therapeutic challenges,
because they are associated with an increased risk of falls, a decrease in the functional capacity and quality of
life of these patients.
Materials and Methods. The study included 25 patients with Parkinson’s disease stages I-III Hoehn-Yahr,
from Baile Tusnad. The patients received treatment consisting of individual carbonated mineral water baths
for 15 minutes twice a week, climatotherapy and aerotherapy for 30 minutes daily, aquatic exercises in a
carbonated mineral water pool for 30 minutes daily, laser therapy, special massotherapy and kinesiotherapy,
performed daily for 14 days. Each patient was assessed clinically before and after treatment, at 3 and 6 months,
by the 10 Meter Walk Test, TINETTI Gait and Balance Scale, Webster Scale, Quality of Life Scale, Visual
Analog Scale for Pain, adverse reactions.
Results. At the end of treatment, an increase in the walking distance and speed, a statistically significant
improvement of gait was observed, p<0.05. Statistically significant results (p<0.05) were also obtained when
assessing pain and balance. For the Webster Scale, which examines the limits of movement and autonomy, a
p value <0.05 was obtained. The Quality of Life Scale showed a statistically significant p value <0.05. The
results were also statistically significant at 3 months, the patients continuing the exercises at home, and their
mobility was better at 6 months as well. There were no side reactions to the treatment applied.
Conclusions. The rehabilitation program including aquatic exercises influenced the clinical picture and
functional capacity, determining a significant relief of pain, an improvement of the mobility, balance and
quality of life of these patients. The positive effects of hydro-kinesiotherapy can contribute to the improvement
of biomechanical gait patterns in patients with Parkinson’s disease.
L2
L3 - INFLUENCE OF HOT FOSSIL SAPROPELIC MUD PACKS ON BLOOD PRESSURE
VALUES AND HEART RATE
VARODI Mariana¹ , DOGARU Gabriela²
Corresponding author: VARODI Mariana, email: nicovarodi_bft@yahoo.com

1.Ocna Sibiului Strand Spa Complex

2.Clinical Rehabilitation Hospital Cluj-Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
Abstract.
Introduction
The main use of Ocna Sibiului resort is for rheumatic diseases, but persons who come for treatment here (at
the indication of the family physician, the specialist doctor or most frequently on their initiative) are in their
great majority (>50%) aged between 60 and 85 years, and frequently have associated disorders: HTN, CIHD,
cardiac rhythm disorders, etc. Due to the effects derived from its physical properties and chemical
composition, fossil sapropelic mud in Ocna Sibiului is used in therapy at the treatment facility as partial or
general hot mud packs, at temperatures of 38-40 degrees. It is known that heat application induces an increase
in heart rate and cardiac output, an increase in the blood circulation speed, a reduction of peripheral vascular
resistance, and a decrease in systolic and diastolic blood pressure values.
Objectives
To evaluate the influence of hot fossil sapropelic mud packs in Ocna Sibiului resort on blood pressure values
and heart rate.
Material and method
40 patients who received treatment (for at least 10 days), which included hot mud packs. BP values and heart
rate were measured before and after the procedure.
Results
The patients were assessed depending on age, sex, presence/absence of HTN, CIHD, cardiac conduction, and
rhythm disorders. In the majority of the cases, an increase in heart rate occurred after the application of hot
mud packs, while blood pressure values decreased, these findings being in accordance with the literature data.
Conclusions
Using natural therapeutic factors yields good results in the therapy of a wide range of degenerative,
inflammatory or abarticular rheumatic diseases, post-traumatic locomotor system disorders, neurological,
dermatological diseases, metabolic diseases, etc., but treatment should be adequately dosed and indicated
taking into account the associated disorders of patients. If heat application is prolonged, BP values normalize
or even increase by 10-20 mmHg. In elderly patients, high-intensity thermal stimuli may induce paradoxical
vasoconstriction reactions. The sudden application of a temperature >40 degrees causes profound
vasoconstriction, with mobilization of blood from reservoirs and an increase in systolic blood pressure.
L3
L4 - Potassium and mineral waters, therapeutic effects in cardiometabolic diseases
GÁSPÁR Boróka-Panna¹, DOGARU Gabriela²
Corresponding author: GÁSPÁR Boróka-Panna, E-mail: g.boro@hotmail.com
1. “Prof. Dr. Ioan Puşcaş” City Hospital, Şimleu Silvaniei, Romania

2. "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
Abstract.
Introduction. Deficiency of mineral elements plays a role in the development of diabetes mellitus, modulates
glucose levels and blood pressure. Potassium has been identified as a shortfall nutrient, low potassium levels
being associated with type 2 diabetes. Mineral waters with their proper bioavailability could be considered an
elective source to influence electrolytic homeostasis; crenotherapy may contribute to daily intake of mineral
elements.
Material and method. Studies and reviews describe and summarize the physiological mechanisms and
characteristics of mineral nutrients, daily requirements, presenting and highlighting the preventive and
therapeutic role of mineral waters in cardiometabolic diseases, as part of a balneological approach.
Results and discussions.
Type 2 diabetes mellitus is a worldwide epidemic, a cardiovascular risk factor, which may develop in any
case, especially in the presence of a pre-diabetic status (impaired beta-cell function and increased insulin
resistance) and in the presence of genetic (more than 40 susceptibility genes) or epigenetic (obesity, sedentary
lifestyle, hypertension) factors. Glucose control might be affected by dyselectrolytemia, given that low
potassium levels are associated with type 2 diabetes risk, leading to insulin resistance. Considering a
therapeutic approach, reviews report that reduced sodium administration (diminish arterial stiffness) and
increased potassium intake (improved endothelial function and NO release, vasodilatation, increased
natriuresis, ameliorate sympathetic nervous system effects) can lower blood pressure. A number of studies
support the role of potassium in glucose control. A potassium-rich diet or potassium supplementation is part
of a preventive treatment method in diabetes and hypertension. Mineral waters in considerable amounts could
contribute to meeting nutritional needs. Microelements from water are characterized by more preferable
bioavailability and better absorption compared to food. Bicarbonate-, sodium-, chloride- and sulphate-rich
mineral water, as well as calcium, magnesium, fluoride and potassium content has been documented in the
medical literature on glucose control, by evaluating glucose homeostasis-related parameters. Balneoclimatic
resort recommendations in cardiometabolic diseases are: Covasna, Băile Tuşnad, Borsec, Călimăneşti-
Căciulata, Olăneşti, Slănic Moldova, Vatra Dornei.
Conclusions.
Adequate potassium intake influences glucose and blood pressure control; mineral waters could be an elective
source for health maintenance and prevention of cardiometabolic disease.
Key words: mineral water, potassium, diabetes, blood pressure
1. Khan RMN, Chua ZJY et al. - From Pre-diabetes to diabetes: Diagnosis, treatments and translational research, Medicina 2019
Aug; 55 (9), pii: E546
2. Costa-Vieira D, Monteiro R, Martins MJ - Metabolic syndrome features: Is there a modulation role by mineral water
consumption? A review. Nutrients 2019 May 22;11 (5), pii E1141
3. Toxqui L, Vaquero M P - An intervention with mineral water decreases cardiometabolic risk biomarkers. A
4. crossover, randomized, controlled trial with two mineral waters in moderately hypercholesterolaemic adults, Nutrients 2016
Jul; 8(7):400
5. Stone MS, Martyn L, Weaver CM - Potassium intake, bioavailability, hypertension, and glucose control, Nutrients 2016 Jul;
8(7): 444
6. Iqbal S, Klammer N Ekmekcioglu C - The effects of electrolytes on blood pressure: A brief summary of metaanalyses, Nutrients
2019 Jun 11(6): 1362
L4
L5 - THE PRACTICAL APPROACH TO COMORBIDITIES IN RESPIRATORY
REHABILITATION
Doina-Clementina Cojocaru, Paraschiva Postolache
Presenting author D.C.Cojocaru, E-mail: clementina.cojocaru@gmail.com

“Grigore T. Popa” University of Medicine and Pharmacy Iași, Romania, Faculty of Medicine
Department of Medical Specialties (I), Clinical Rehabilitation Hospital Iași, Romania
Pulmonary Rehabilitation Clinic
Abstract.
Introduction: Pulmonary rehabilitation is an effective intervention in chronic respiratory diseases, as many
trials have documented. Comorbidities, defined as conditions associated with the primary disease, can alter
the clinical course, therapy response, and prognosis of respiratory patients. The aim of the presentation is to
assess the impact of major comorbidities on the pulmonary rehabilitation program, a major component of the
therapeutic plan.
Materials and methods: Identification of the common comorbidities added to primary respiratory diseases
and practical approach of a patient with complex pathology before and during a pulmonary rehabilitation
program, according to the current data from literature and the experience of Iași Pulmonary Rehabilitation
Clinic.
Results: The most common comorbidities identified in patients with chronic respiratory diseases, prior to the
beginning of the rehabilitation program are cardiovascular diseases, diabetes, and metabolic syndrome, as well
as musculoskeletal pathology. Pulmonary patients associating cardiovascular diseases tend to have more
intense dyspnea, inappropriate tachycardia, and blood pressure values during physical effort, in terms of
excessive increase or a sudden drop in systolic blood pressure. As well, these patients frequently experiment
angina pain during training, requiring close monitoring (rest ECG, Holter monitoring) and a specific
medication (beta-blockers, nitrates, ivabradine). In the presence of malignant arrhythmias or pulmonary
hypertension, the risk of syncope during effort has to be properly managed. Diabetics require tighter glycemic
control during the program through adjustment of insulin and oral medication, considering the improvement
in the insulin resistance of physical exercise and the hypoglycemic effect. Patients with severe musculoskeletal
pathology and claudication are mechanically limited in physical performance and medication for osteoporosis
(bisphosphonates) favors gastroesophageal reflux, at night during drainage postures, leading to worsening
cough and dyspnea.
Conclusions: Comorbidities in chronic respiratory diseases have a considerable impact on the safety and
efficacy of pulmonary rehabilitation programs, demanding a comprehensive interdisciplinary approach.
L5
L6 - Modelul holistic de recuperare si îngrijirea pacienților cu afecțiuni ortopedice si
neurologice in bazele de tratament Călimănești-Căciulata-Cozia
Dr. Eugenia Dumitrescu, Medic primar recuperare, MF si balneo-climatologie
Dr. Carmen Enescu, Medic șef baza de tratament Calimanesti-Caciulata Cozia
Corresponding author: Eugenia Dumitrescu, E-mail: jenydumitrescu2003@yahoo.com
Abstract.
Introducere. Se pune mereu întrebarea : ultra specializare sau medicina holistica? La ora actuala ne confruntam cu o
nevoie sporita de servicii de recuperare de calitate. Cauza: numărul mare de accidente rutiere si AVC la vârste tot mai
tinere. Balneoclimatologia la Claimanesti-Caciulata a străbătut o perioada foarte dinamica de modernizare, accelerate
in ultima decada. Au fost proiecte majore de dotare cu aparatura piscine si echipamente moderne din diverse surse de
finanțare. Creșterea calității îngrijirilor medicale depinde de echipa de recuperare. Modelul occidental de recuperare
trebuie sa fie obligatoriu si in stațiune.
Material si metoda. Testele clinic au fost făcute pe un număr de 590 pacienți care au urmat tratament in bazele de
recuperare Călimănești-Cozia in perioada februarie 2019 – dec 2019. Media de vârsta 55 ani cu limite de vârste 27-80
ani. Distribuția geografica a pacienților: din întreg teritoriul României cu predominanta Argeș, Dolj, Ilfov, Olt,
Teleorman. 402 pacienți din mediu urban, 188 pacienți din mediu rural.
Patologie:
- Sechele, accidente de circulație cu leziune de coloană si cerebrale 91 pacienți
- Sechele AVC 112 pacienți
- Osteosinteza post fracturi 387 pacienți
Toți pacienți au avut MRI. Am abordat holistic pacienții pentru ca multe cazuri a fost vorba nu numai despre leziuni
fizice ci si despre reale trauma psihice. In tratament ne-am bazat pe deviza lui Sebastian Kneip considerat părintele
balneologiei: ”Inactivitatea slăbește, exercițiul întărește, excesul produce daune.”
Abordarea pacienților a fost multidisciplinara, pentru ca atât ortopedul cat si neurologul au venit cu o contribuție. Am
introdus terapia durerii(farmacologic sau non farmacologic) pentru ca la o durere de gradul 3-4 pe scara numerica de
evaluare de la 0-10 nu se poate face recuperare.
Terapia fizica antialgica a constat in: Împachetări calde si stimulare electrica nervoasa trans cutanată-TENS.
Componenta centrala in structurarea programului de recuperare a fost exercițiul fizic la sala in piscine sau la cada. După
o evaluare clinica si funcțională atenta si o stratificare a riscului antrenamentul fizic a fost individualizat pentru fiecare
pacient. In practica medicala zilnica am folosit si chestionarele legate de calitatea vieții. Reinsertia sociala a pacienților
a fost scopul final al recuperării; Pentru alți pacienți obiectivul final a fost ameliorarea calității vieții.
Rezultate
- 295 pacienți au plecat fără durere si cu posibilitatea de auto îngrijire
- 225 pacienți au dorit sa mai urmeze încă 10 zile de recuperare pentru perfecționarea abilitaților de mișcare
- 70 pacienți necomplianți; factorii stresori psihosociali au contribuit la creșterea comportamentelor de risc de tip
fumat, abuz de alcool, obezitate, inactivitate fizica, nerespectare a tratamentului.
Prezenta depresiei a triplet riscul de non complianță. Lipsa psihologului in echipa de recuperare s-a observat; eșecul de
a detecta distresul provocat de accident rutier sau AVC a fost o bariera in calea tratamentului adecvat.
Calitatea vieții a fost dificil de măsurat, scorurile de calitate a vieții nefiind unitare, totuși potrivit chestionarelor foarte
mulți pacienți si-au dorit un job adaptat particularităților lor.
Concluzii
1. Tratamentul de recuperare in stațiunea Calimanesti-Caciulata rămâne o provocare; se fac trimiteri in stațiune inutile
si se blochează oameni care chiar au nevoie
2. Recuperea in stațiune ar trebui sa dureze minim 21 de zile, deoarece reinsertia sociala a pacienților este scopul final
3. Calitățile cheie pentru a avea succes in recuperare sunt: compasiune, răbdarea si perseveranța deoarece recuperarea
este una dintre cele mai imprevizibile specialități medicale
4. Speram ca in 2020 balneologia sa aibă locul ei bine meritat, acela de profilaxie si recuperare, cu o echipa complete
iar noi medicii sa primim mai mult ajutor din partea sistemului.
L6
L7 - Current overview and reappraisal on essays towards systematizing clinical assessment
instruments used to evaluate neuro-functional deficits after stroke including through the
ICF(-DH) conceptual framework
Gelu ONOSE 1,2, Vlad CIOBANU 3, Carmen FIRAN 4, Aurelia ROMILA 5,6,
Maria Veronica MORCOV7
Corresponding author: Prof. Dr. Gelu Onose, E-mail geluonose@gmail.com

1 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
2 Teaching Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
3 Politehnica University of Bucharest, Computer Science Department
4 Teaching Emergency Hospital of the Ilfov County
5 “Dunarea de Jos” University of Galati, Romania
6 Teaching County Emergency Hospital “Sf. Apostol Andrei”, Galati, Romania
7 The National Teaching Centre for Neuro-psycho-motor Rehabilitation in Children “Dr. N. Robanescu”, Bucharest, Romania
Abstract
Introduction. We herein continue our series of works dedicated to current reappraisals on clinical
assessment instruments designated to evaluate functional deficits in the main neurologic/ neurosurgical
conditions. The actual one refers to the most frequently used such instruments in stroke.
Like we have previously asserted the “… WHO (World Health Organization – o. n.)’s modern kind of
endeavor matches with another contemporary advanced concept: of ‘Evidence-based Medicine’, an already
renown proceeding for correct and complete/minute diagnosis and prognosis, and respectively, for
consequent, specific therapeutic-rehabilitative, social, occupational – if applicable – decision-making, and
consequent appropriate interventions.
Material and method. As in our previous works of this kind, we review the related essays towards
systematization through the WHO’s new paradigm to approach human functioning: International
Classification of Functioning, Disability and Health (ICF-DH) – as it is progressing towards implementation
– based on an updated preliminary literature review.
Results. This approach encompasses:
- a related literature review
- some synthetic considerations regarding the actual clinical-epidemiological status of stroke
- brief emphasizes on basic characteristics of the WHO’s ICF(-DH)
- an overview on the clinical assessment instruments used in stroke and their proposed framing within
the ICF(-DH).
Conclusions. General remarks and perspectives in the domain are made, acknowledging the necessity to
continuously keeping updated, making reappraisals and selecting to use in practice the most appropriate
related evaluation tools – considering both: their international recognition and acceptance and respectively,
the specific effective possibilities for their impelmentation.
Key words: stroke, literature review, International Classification of Functioning, Disability and Health
(ICF-DH), assessment instruments/ measurement scales
Selected references:
1. International Classification of Functioning Disability and Health (ICF). World Health Organization
(WHO) – Geneva, 2001; https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf
2. World Health Organization. (2007). International classification of functioning, disability and health:
children and youth version: ICF-CY. World Health Organization.
https://apps.who.int/iris/handle/10665/43737
3. MacDonald B K, Cockerell O C, Sander J W, Shorvon S D. The incidence and lifetime prevalence of
neurological disorders in a prospective community-based study in the UK. Brain 2000;123 (4): 665-76
L7
L8 - Multifactorial Gait Analysis of the independent walking onset of children with
unilateral cerebral palsy
Anca Irina GRIGORIU1, Liliana PADURE 1,2

Corresponding author: Anca Irina GRIGORIU, E-mail: an_ir_ra@yahoo.fr
1. National Center of Rehabilitation for Children „Dr. N. Robanescu”, Bucharest, Romania

2. University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania
Abstract
Introduction. Multifactorial Gait Analysis is an important instrumented tool of gait assessment. Knowledge
on the development of the independent gait development for infants with cerebral palsy is limited. This
study aimed to compare the gait biomechanical parameters during the first six months of independent
walking of toddlers with unilateral cerebral palsy (UCP) with those of typically developed (TD) infants
matched for walking experience.
Materials and methods. Fifteen TD toddlers and twelve UCP children, with a maximum walking
experience of six months, were recorded using a 3D optoelectronic system and a dynamic surface EMG
system. Data on spatiotemporal parameters, kinematics and EMG activation during walking were collected.
Statistical parameter mapping was used for kinematic and EMG comparison. Mann–Whitney U test was
used to compare spatiotemporal parameters between groups.
Results. Toddlers with UCP had bilateral modifications of the spatiotemporal parameters during gait as
compared with TD toddlers and temporal asymmetry. The largest kinematic difference between the UCP and
TD groups was external pelvic rotation on the affected side (13.3°). The groups did not differ in muscle
activation for the set of muscles recorded.
Conclusions. Gait analysis should be a standard assessment of children with cerebral palsy, no matter their
age. In very young infants, this assessment remains challenging and difficult. The dominant biomechanical
modification in infants with UCP during the first six months of independent walking is proximal. At this
age, the excessive pelvic retraction of the affected side is likely to be due to abnormal initial motor control
disorders more than compensatory mechanisms. The findings of this study provide evidence for early motor
interventions focusing on the proximal level in order to optimize gait development at the earliest stages of
children with UCP.
L8
L9 - Balance rehabilitation in neurological patients
Ana Maria Bumbea
anamariabumbea@yahoo.com
Abstract.
Introduction: The neurological patient presents a series of physical deficiencies, and a correct balance is a
pillar of resistance.
Material and method: Balance recovery starts with a correct assessment of the degree of balance dysfunction.
Initially, it is used a large support surface, and then the reduction of the support surface. The mode of
application differs depending on the type of neurological impairment. Different techniques are used to affect
the degree of balance.
Results: The techniques applied as soon as the onset of the neurological disorder led to a better improvement
of the balance deficit in the neurological patient.
Conclusions: It was found that the recovery time was reduced as the rehabilitation techniques were applied
early. The correct recovery of the balance will allow the recovery of the gait and the acquisition of other
gestures in carrying out the daily activities
L9
L10 - The Benefits of Shockwave Therapy in Calcific Tendinitis of The Shoulder
Otilia ROGOVEANU1, 2, Andra CRUCERU2, Cioroianu GEORGE2, Alesandra FLORESCU3,

Cristina GOFIȚĂ3, Rodica TRĂISTARU1
Corresponding author: Otilia ROGOVEANU, E-mail: otilia.rogoveanu@gmail.com
Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L10 OP Vol.11, No.3, September 2020 p:
1. Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Romania
2. Department of Physical Medicine and Rehabilitation, Emergency Clinical County Hospital of Craiova, Romania
3. Department of Rheumatology, Emergency Clinical County Hospital of Craiova, Romania
Abstract
Introduction. Objectives. Shockwave therapy (SWT) is a noninvasive treatment that involves creating a
series of low energy acoustic wave pulsations that are directly applied on a painful joint. Generated
shockwaves have proven successful in different pathologies such as calcific tendinitis, plantar fasciitis and
bursitis. Calcific tendinitis of the shoulder is one of the most common causes of shoulder pain that occurs
when calcific deposits build up inside or around the tendons of the rotator cuff. The purpose of the study was
to determine the beneficial effects of SWT on pain compared to other physical methods of therapy.
Materials and methods. In this study we included 40 patients between 40 and 55 years old, 20 women and
20 men. The criteria for inclusion in the study were shoulder pain lasting for more than a month and limited
joint mobility. Patients were evaluated clinically, para-clinically and by musculoskeletal ultrasound
examination of the painful shoulder. Pain was measured on the visual analogue scale (VAS). Then the patients
were divided in two groups, the first one received SWT and the other one received laser, ultrasound therapy
and nonsteroidal anti-inflammatory drugs.
Results. Musculoskeletal ultrasound examination of the shoulders revealed increased thickness and hypo-
echogenicity of the subscapular and supraspinatus tendons in 95% of cases, calcific deposits in 80% of patients
and partial tendon ruptures in 30% of cases. Mean VAS was decreased by 58.88% in the first group of patients,
while the second group reported a decrease of only 30.12% in mean VAS. The calcific deposits measured
using ultrasound were smaller in length in the first group after SWT. Both groups showed an improvement of
shoulder mobility in 78% of patients in the first group and 55% of cases in the second group.
Conclusions. Shockwave therapy significantly reduced the pain that accompanies tendinitis of the shoulder
and improves functionality and quality of life. It might be first choice because of its effectiveness and safety.
The use of SWT in calcific tendinitis of the shoulder proved superior compared to conventional physical
procedures.
L10
L11 - The Importance of Physical Therapy in Ankylosing Spondylitis
Otilia ROGOVEANU, Andra CRUCERU, Cioroianu GEORGE, Alesandra FLORESCU,

Anca MUȘETESCU, Ana Maria BUMBEA, Dan CAIMAC
Corresponding author: Otilia ROGOVEANU, E-mail: otilia.rogoveanu@gmail.com

1. Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, Romania
2. Department of Physical Medicine and Rehabilitation, Emergency Clinical County Hospital of Craiova, Romania
3. Department of Rheumatology, Emergency Clinical County Hospital of Craiova, Romania
4. Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Romania
Abstract
Introduction. Objectives. Ankylosing spondylitis (AS) is a pathology of high complexity, in which there is
required both an extensive clinical and biological evaluation as well as a comprehensive imaging evaluation.
In order to improve the quality of life and also the patients’ range of movement, there is required a
multidisciplinary approach and the application of both pharmacological and non-pharmacological treatment.
The purpose of the current study is to assess the disease activity of patients diagnosed with AS before and
after non-pharmacological treatment.
Materials and methods. Our study included a number of 27 patients, 22 males and 5 females, with minimum
age of 17 years, maximum age of 60 years, mean age of 41.55 years and mean disease duration of 7.7 years.
All patients were recommended rehabilitation therapy, especially those with a predominantly axial form of
AS. The therapeutic protocol was performed either individually by the patient or in classes guided by a
physical therapist, 3 times per week for 1 hour over a period of 3 months.
Results. The patients had either the axial form of AS (19%), peripheral form of AS (27%) or the combined
involvement of the axial and peripheral form (54%). Disease activity calculated using Ankylosing Spondylitis
Disease Activity Score (ASDAS)-CRP was within moderate range in 12% of patients, high range in 9% of
cases and very high range in 79% of the patients. BASDAI mean values were 7.51. The mean registered value
of BASFI was 7.79. The patients were reevaluated after 3 months of treatment with NSAIDs, DMARDs and
physical therapy. Disease activity scores and functional indices were reassessed, with a mean value of ASDAS
of 3.69 in contrast with 4.77 before treatment. BASDAI mean values were 7.03, as well as BASFI recalculated
values had a mean of 6.91. BASFI individual and mean values decreased significantly after the 3 months of
combined treatment, from a mean value of 7.79 to 6.91, minimum and maximum values also decreasing from
1.7 to 1.6 and from 9.6 to 8.4, respectively.
Conclusions. The beneficial effects of both pharmacological and non-pharmacological therapies, have been
demonstrated in long and short-term studies by a visible improvement in the patients’ quality of life, thus
underlining the importance of a multidisciplinary approach to patients with AS.
L11
L12 - PSORIASIS AND CHRONIC DEFORMING AND EROSIVE TOPHACEOUS GOUT -
ASSOCIATION OF COMPLEMENTARY RISK FACTORS FOR CEREBRAL
INFARCTION. CASE PRESENTATION, PHYSIOPATHOLOGICAL CONSIDERATIONS
Aurelian Anghelescu1,2, Sabina Solcan1, Constantin Elena1, Pandrea Alexandru1, Prof. Dr. Gelu Onose
1,2
1
Spitalul Clinic de Urgență “Bagdasar-Arseni” (SCUBA), București, România;
2
Universitatea de Medicină și Farmacie ”Carol Davila” (UMFCD), București, România
Abstract.
Introduction: Oxidative stress is one of the main mechanisms involved in the pathophysiology of
inflammatory and neurodegenerative diseases of the CNS. The association between psoriasis and
cardiovascular disease is an etiopathogenic dilemma, many studies have shown an increased risk of
cardiovascular morbidity in patients with psoriasis, compared to the general population. The prevalence of
gout is 6% men and 2% women. Gout is a risk factor for multiple pathologies including cardiovascular disease,
being the equivalent of diabetes on vascular pathology. The association of gout with myocardial infarction or
stroke is not very clear, the relationship between uric acid and prognostic of stroke remains debatable. Uric
acid is the end product of purine catabolism, and the main endogenous blood antioxidant; it potentiates the
neuroprotective effects of rt-PA (tissue plasminogen activator). Despite the above, an increased level of uric
acid can be considered as an independent risk factor for stroke. Too high or too low uric acid concentrations
are associated with a negative prognosis of stroke. Although uric acid is an endogenous primary antioxidant
with neuroprotective potential, patients with cerebral ischemia and excessively high levels of uric acid (> 380
μmol / L), or too low uric acid (≤250 μmol / L), are at risk of 2-3 times higher for poor prognosis of stroke,
compared with patients with normal uric acid levels (250-380 μmol / L).
Case presentation. A 47-year-old male patient was admitted in subacute stage of capsulo-
thalamic ischemic stroke (October 31, 2019). Neurological examination revealed predominantly left
hemiplegia, locomotor deficiency, hemihypoesthesia, left-sided homonymous hemianopsy. The medical
history: capsulo-thalamic ischemic stroke, HTA-E st III (neglected, diagnosed in December 2018), chronic
tophaceous gout (diagnosis in 1998, treated with Colchicine and Milurit), psoriatic arthropathy (2016),
cholecystectomy (2001), chronic smoking, for over 30 years. The patient has deformed gouty tufts at the
level of the right achilles tendon (with local suppuration), left achillian tendon, hallux bilateraly, the right
elbow joint, right hand. It was evaluated clinically and functionally, according to the standardized protocols
implemented in our clinic (ADL, IADL, Barthel, MMSE, FIM, QOL, Asworth Penn, FAC, Stratify risk
scale, GOS-E, modified Rankin, MOCA) and paraclinic by laboratory analysis, joints radiographs
(hands, elbows ankle joints), cerebral CT. The patient received a complex neuromuscular recovery
program (synergistic association of neurotrophic factors, metabolic modulating medication,
kinetotherapy). No corticosteroid medication was needed in topical application on the psoriatic
lesions. The evolution was favorable with neurological improvement, reflected by the neurological
evolution and quantified by the upward curve of the clinical scores. Improvement of the short distance
walking, static and dynamic balance were obtained; at discharge he performed independent walking on
short distances with a tetrapod stick.
Secondary prophylaxis addressed the control of the risk factors that could be influenced: the
metabolic dysfunction (diet and medication), optimization of blood pressure, smoking (health education
and patient's will); psoriasis is the only less influential etiopathogenic risk factor.
Conclusions: The current standard of management of patients with stroke and multiple comorbidities
(gout, psoriasis, HTA, chronic tobacco) is represented by the multidisciplinary approach, for secondary and
tertiary prophylaxis, in order to improve their quality of life.
Keywords: Stroke, gout, psoriasis, smoking, neuroprotection, oxidative stress,
L12
L13 - Protocol for physiotherapeutic treatment in the recovery of scapulohumeral periarthritis
Catalin Ionite1, Iustina Condurache1, Mariana Rotariu1*
Corresponding author Mariana Rotariu, E-mail address: rotariu29@yahoo.com

1
University of Medicine and Pharmacy „Grigore T. Popa”, Street University, no 16, Iași, România
Abstract.
Introduction
Scapulohumeral periarthritis is a clinical syndrome that affects both performance / leisure athletes and ordinary
people, by affecting the periarticular structures. This syndrome results in decreased muscle strength, joint
mobility and increased pain at the scapula-humeral joint.
Material method
The present study was performed on a group of 30 subjects diagnosed by the specialist doctor with
scapulohumeral periarthritis. The group was evaluated initially, but also final. The pain felt by the patient in
the joint was evaluated using the Visual Analog Pain Scale. The measurements were made in the frontal plane
on the useful sectors of mobility (0o-45o, 45o -90o and 90o -150o). The results of the measurements were
correlated with the muscular force corresponding to the movement sector.
Between the two assessments, the group of subjects benefited from a physiotherapeutic plan consisting of
physiotherapy combined with proprioceptive (relaxation-opposition) neuromuscular facilitation techniques
daily, for a period of 10 days. All data obtained from the two tests were taken, inventoried and compared.
Results
Analyzing results obtained after the evaluations, it was found after the treatment period a significant decrease
of the pain in all the three mobility intervals (0o-45o, 45o -90o and 90o -150o) concomitant with an increase of
the muscular strength, implicitly of the amplitude of motion.
Conclusions
Due to the positive results obtained, the treatment protocol developed and applied in the present work has led
to the improvement of the symptoms generated by the scapulohumeral periarthritis syndrome.
Keywords: scapulohumeral periarthritis, physiotherapeutic treatment, evaluation
L13
L14 - IMPROVING FUNCTIONAL AND MOTOR CAPACITY THROUGH
MEANS/RESOURCES AND METHODS SPECIFIC TO ACVATIC ACTIVITIES
Mariana Rotariu1*, Marius Turnea1 , Dragos Arotaritei1 , Catalin Ionite1, Iustina Condurache1

1
University of Medicine and Pharmacy „Grigore T. Popa”, Street University, no 16, Iași, România
Abstract.
Introduction
Exercise programs in the aquatic environment have as their main objective the improvement and maintenance
of physical capacity/ capability, these being in continuous development and diversification. Water exercise
amplifies the effects of general physical exercise, by allowing a more precise control over the movement of
each body segment and of the body as a whole.
The aquatic environment offers a number of beneficial effects compared to ones offered by the terrestrial
environment. The benefits obtained through the aquatic activities are fundamental and are reflected throughout
the entire body including both motor, functional and aesthetic level.
Material and Methods
The objective of this study is represented by the identification of new forms of physical exercise that will
increase the effort’s capacity. In order to achieve this goal, several methodological requirements were met,
such as: successive engagement of the joints and muscle groups in effort (starting with the neck’s muscles,
shoulders, arms, torso and legs, simultaneously with scapular-humeral joints, spine and coxo-femoral joints
and legs), the gradually usage of exercises, starting with the most basic and then increasing the complexity of
the exercises, the usage of the accessible exercises in the beginning of the training, executed with high
amplitude and reduced speed, focusing on the correctness of the execution, the selection and the adequate/
appropriately usage of the initial positions according to the subject’s particularities and the shape/form of the
exercise, the optimal control of the effort, achieved through a number of iterations, optimal execution time
and breaks, the sets of general physical exercises will consist of sets of 8-12 exercises/reps, the principle of
symmetry in the execution of the exercises has to be respected, the continuity of practicing a set of exercises
for 6 to 8 consecutive lessons, the recommended work method is fragmented-imitative, efficiently combining
the explication with the demonstration, the number of repetitions and the movement’s correction.
Results
Analyzing results obtained after the evaluation, we have noticed significant growth in the functional and
motor capacities.
Conclusions
The systematization of water activities on objective criteria effectively contributes to their knowledge, while
allowing them to be included in the spectrum of recreational, sporting, relaxing or therapeutic activities.
Keywords: acvatic activities, physical exercise, evaluations
L14
L15 - Efficiency of Complex Medical Rehabilitation Programs in Assisting the Patient
with Painful Shoulder Syndrome
Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Oleg PASCAL1, Ana – Maria BODEAN1
Corresponding author: Victoria CHIHAI, E-mail: victoria.chihai@usmf.md

1.The University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau, Republic of Moldova, The Department of Medical
Rehabilitation, Physical Medicine and Manual Therapy
Abstract
Introduction. Painful shoulder syndrome is a clinical syndrome characterized by pain, redness and functional
impotence at the scapula humeral belt. The pathological changes affect both the hard and the soft structures at
this level with chronic evolution and severe clinical and functional limitations. Shoulder joint is one of the
most mobile joints with degrees of freedom in nerve injuries or compressive disorders can cause severe
functional pain and disability with significant limitation of daily activities and quality of life. [1,4] Combining
various conventional methods of recovery between them but also with other types of treatment can increase
the chances of clinically and functionally recovering of people with painful shoulder syndrome. [3]
Case presentation. Patient B.B. age 50, urban environment, specialized surgeon was admitted to the IMSP
"State Hospital" accusing persistent pain in the right shoulder with limiting active movements of about 3
months until addressing. After the complex evaluation, the functional diagnosis was established. Painful mixed
shoulder syndrome on the right. Mixed red shoulder straight. At the primary examination, the pain was
assessed with 8 points after the Visual Analog Scale (VAS) and 69 points after the McGill questionnaire.
Goniometric indices for the right shoulder: ext / fl = 150/00/980; abd / add = 280/00/00. The painful bow tests
Empty-can, Apley, Codman were rated positively. The daily functional capacity was evaluated according to
the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, rated with 30.9 points.
Results. The patient received conventional drug treatment and rehabilitation therapy (kinetotherapy,
magnetotherapy) in combination with Ianliao (TE14), Jianyu (LI15), Fengchi (GB20), Queng (LI11), Waiguan
(SJ5), Hegu LI4, Tianzong (SI 11) for 8 weeks. At the end of the treatment, the pain decreased to 4 points on
the VAS scale and 35 points on the McGill scale. The joint mobility was improved for extension by 50, flexion
- by 130, and the abduction reached the value of 400. The total functional capacity tested by the DASH
questionnaire was assessed with 19.5 points after treatment.
Conclusions. The associated complex program of medical rehabilitation applied to the patient with the painful
shoulder syndrome has contributed firmly to the clinical-functional improvement by diminishing the algal
syndrome, improving the segmental functional capacities and the daily activities. The acupuncture selected on
the energy points can be indicated in combination with kinetotherapy and electrotherapy for the efficiency of
the medical recovery treatment.
Key words: painful shoulder syndrome, evaluation of the shoulder, acupuncture
References
1.Beaudreuil J, Nizard R, Thomas T, Peyre M, Liotard JP, Boileau P, et al. Contribution of clinical tests to the
diagnosis of rotator cuff disease: a systematic literature review. JointBoneSpine.2009 Jan;76(1):15-19
2.Tudor Sbenghe - „Kinetologia profilactica, terapeutică și de reabilitare”2008
3.Wang XY, Zhang YM, Jia YT, Wang H, Yue Q, Wu JK & Chen S. Treatment of 50 Patients with Acute
Shoulder Periarthritis by Hui Acupuncture. JournalofClinicalAcupunctureandMoxibustion. 2015,31(4).
4.http://www.doctorortoped.ro/afectiuni-ortopedie/umar-si-brat/33-durere-umar-ortoped-bucuresti.html
L15
L16 - EVALUATION OF THE ANTINOCICEPTIVE AND ANTI-INFLAMMATORY
ACTIVITIES OF HESPERIDIN AND ITS INCLUSION COMPOUNDS IN MICE
Andreia Corciovă, Bianca Ivănescu, Daniela Carmen Ababei, Ana-Flavia Burlec,

Cornelia Micea, Veronica Bild
“Grigore T. Popa” University of Medicine and Pharmacy, Faculty of Pharmacy, Iași, Romania
Abstract.
Introduction
This study aims to evaluate the antinociceptive activity of hesperidin (HES) and its inclusion compounds
with beta-cyclodextrin (HES-βCD) and hydroxypropyl-beta-cyclodextrin (HES-HP-βCD) on inflammatory
and non-inflammatory nociception models, as well as the anti-inflammatory action.
Materials and Methods

For these experiments, we employed nociception models using thermal stimulus (hot plate and tail
immersion tests, t = 52.5 0C; 30, 60 and 90 minutes testing), chemical stimulus (Zymosan-induced
abdominal constriction response test, using distinct lots and testing at 60, 90 and 120 minutes after
administration of samples) and pressure stimulus (Randall Sellito test) and an inflammation model for the
evaluation of inflammatory edema by Plethysmometer test. Groups of 6-10 Swiss mice / lot were used,
receiving by oral administration suspended substances (HES and inclusion compounds) in 0.1% CMC-Na.
The doses were administered in geometric progression.
All experiments were conducted in strict conformity with the specific regulations approved by "Grigore T.
Popa" University of Medicine and Pharmacy Iași, European bioethical regulations (Directive 2010/63/EU)
and International Association for the Study of Pain regulations.
Results
HES showed antinociceptive and anti-inflammatory activities on all studied models for a 50 % activity level.
The analysis of the obtained ED50 values indicates a higher potency for the non-inflammatory nociception
models (using thermal stimulus) for the 90-minute test and a comparable potency between the inflammatory
nociception models and the inflammatory edema inhibition test.
The inclusion compounds presented different actions for the same activity level. HES-βCD has a higher
potency in thermal stimulation models at 60 minutes, comparable potency observed in inflammatory
nociception models and higher potency in the inflammatory edema inhibition test. HES-HP-βCD did not
show antinociceptive action on thermal stimulation models. The analysis of the ED50 values obtained in
inflammatory nociception models and in the inflammatory edema test demonstrates superior and comparable
potency.
Conclusions
The HES-βCD inclusion compound exhibited antinociceptive action predominantly on experimental non-
inflammatory nociception models, while HES-HP-βCD exhibited anti-inflammatory and antinociceptive
activities predominantly in inflammatory nociception models.
L16
L17 - Influences of Mandible Position and Activities on Human Postural Control
Dragos Petrica SARDARU¹, Daniela MATEI¹
Corresponding author: Dragos Petrica Sardaru, E-mail address: serdarud@yahoo.com
1. University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Biomedical Sciences Department.
Abstract
Introduction. In the last twenty years there have been great debates about the postural control of the human
body and the multisensory integration of the different sensitivity afferences. One of the sensory inputs
analyzed for its supposed influence in the postural control is the temporo-mandibular joint system and its
mechanosensitive receptors. Mandible and different occlusion positions have been analyzed by different
authors for their influence in body posture and sway. The aim of this investigation was to perform a review
of the literature and to critically analyze the relationship between the mandible and postural control.
Materials and Methods. A literature review was carried out with the following key words: temporal
mandibular dysfunction (TMD), jaw position, body sway, dental occlusion and postural control,
posturography. The following online data bases were interrogated: Elsevier - Science Direct, SpringerLink,
ProQuest, and Thomson ISI – Web of Science, Wiley Online Library. Were taken in consideration only the
randomized control trials (RCT) published in the scientific research journals with a minimum score of
impact factor (IF) of 1.
Results. A number of 70 scientific papers were returned at our search but only 60 were taken in
consideration for this review.
Conclusions. Results of the present review suggest that afferent signals from dental occlusion effectively
contribute to balance control and postural control. Furthermore the newer studies found significant
differences in body postural stability between subjects with myogenous TMD and healthy controls.
L17
L18 - Dementia Risk Factors Approach to Patients with Stroke
Ana-Maria FĂTU1, Ana Maria PÂSLARU1, Valerica CREANGĂ-ZĂRNESCU1, Mădălina

VERENCA1,2, Anamaria CIUBARĂ1,3
Corresponding author: Ana-Maria PÂSLARU, E-mail: annapaslaru@gmail.com
1 Department Physical Medicine and Balneology, Emergency Clinical Hospital for Children "Sf.Ioan", Galati, Romania
2 Departament Ginecology, Emergency Clinical Hospital "Sf. Apostol Andrei", Galaţi, Romania
3 Department of Psychiatry, Psychiatry Hospital "Elisabeta Doamna", Galaţi, Romania
Abstract
Introduction. Stroke and dementia are two of the most important causes of disability, dependency and
morbidity in the world. Current evidence suggests that 25-30% of stroke survivors develop immediate or
delayed vascular cognitive disorders leading to dementia.
Material and method. The study was retrospective for a period of 1 year and includ 100 patients. Their
primary diagnosis was stroke and the secondary vascular dementia. In addition, we conducted bibliographic
research in international databases for scientific literature regarding prevention in stroke and dementia.
Results and discussions. Although it appears in older people, over 60 years, dementia is not a normal,
inevitable, aging process of the brain, with 9% of cases being reported in young people. Dementia results
from cumulative burden of several brain pathologies, including vascular disease, even the accumulation of
miniscule ischemic lesions that can be an important substrate of cognitive impairment.
There is no curative treatment, but epidemiological research provides a substantial amount of modifiable risk
factors. Especially cardiovascular risk: hypertension, dyslipidemia and diabetes, can be addressed to prevent
or delay the vascular dementia that occurs after stroke and to increase the efficiency of the recovery. This
involves risk control due to lifestyle factors: physical inactivity, obesity, unbalanced diets, tobacco use,
harmful use of alcohol and social factors like: psychosocial stress, social isolation, low educational
attainment, cognitive inactivity and mid-life depression.
Conclusions. Prevention strategies of vascular dementia should be aimed at reducing the level of exposure
of individuals to risk factors and strengthening their ability to change their lifestyle in the direction of health
promotion.
Key words: dementia, stroke, risk factors, cognitive, decline
L18
L19 - The Role of Chemokines and Autoantibodies in the Pathogenesis of Systemic
Sclerosis
Mihaiela CHICU1,2, Carmen ANTON1
Corresponding author: Mihaiela CHICU, E-mail: mihaielabitere@yahoo.com

1. University of Medicine and Pharmacy U.M.F. “Gr.T. Popa” Iasi, Romania

2. Clinical Emergency County Hospital “Sf. Spiridon” Iasi, Romania
Abstract
Introduction. Scleroderma is a chronic multisystem disease of conjunctive tissue, with unknown etiology
characterized by fibrosis and degenerative lesions of the skin and internal organs (lungs, heart, kidneys,
digestive tract).
The incidence is 9-19 new cases / 1 million inhabitants.
The disease is predominantly women, with a ratio F:M of 5: 1 and even 14: 1. The age of onset is in the
range 30-50 years. The main etiological factors of the disease are environmental factors or silicon powder,
polyvinyl chloride, silicone implants, aniline, gadolinium.
Discussions. Various chemokines have been implicated in altering angiogenesis, endothelial dysfunction
and the blood vessels.
The main types of chemokines with a role in the pathogenesis of systemic sclerosis are: CCL2, CCL7,
CCL13, CXCL8, CXCL1, and CX3CL1.
Systemic sclerosis associates a wide variety of autoantibodies. Only 10% of the patients do not have the
autoantibodies.
Anticentromere antibodies, the antiARN III synthase antibodies, the antitopoizomeazis 1 antibodies are
considered to be highly specific. AntiU3RNP antibodies, antiU1RNP, anticentromere antibodies are
frequently associated with pulmonary hypertension. AntiARN polymerase III antibodies increase the risk of
developing lung and breast malignancies in patients with systemic sclerosis.
Conclusions. Pathogenic role of chemokines or autoantibody is not well known yet. The two main theories
about the role of antibodies in scleroderma pathogenesis involves on the one hand the enhance of immune
response, and on the other hand the direct pathogenic effect.
Key words: systemic sclerosis, chemokines, autoantibodies
L19
L20 - The effects of cupping therapy in the treatment of lumbar algal syndrome
Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Svetlana PLEȘCA1, Maxim LUPU1
Corresponding author: Victoria Chihai, E-mail: victoria.chihai@usmf.md
1. State University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau, Republic of Moldova

The Department of Medical Rehabilitation, Physical Medicine and Manual Therapy
Abstract.
Introduction
Lumbar algal syndrome is defined as pain that persists over 12 weeks and is determined by degenerative or
traumatic vertebral processes. Chronic back pain is the most costly benign health problem faced by patients in
industrialized countries and one of the most common causes of limiting the activity of persons under 45 years
of age. [2,4] The treatment of chronic back pain can be structured. in 3 phases depending on the duration of
symptoms. From the first stage of the disease, physiotherapy with analgesic effect, miorelaxant, and anti-
dementia is recommended, in combination or not with the drug treatment. [3,5] These treatment schemes may
also be followed in the following stages of pathology.
Case presentation
Patient B.C. male, 44 years old, originally from the rural area, as a driver was admitted to the IMSP "State
Hospital" (Chisinau), with accusations of pronounced lumbar pain, stinging and irradiation in the lower limb
straight up to the knee level with acute exacerbation during the meal and prolonged orthostastatism. From
anamnestic: The patient is a smoker for 20 years, leads a sedentary lifestyle, lumbar pain for 6 years with
exacerbations 2-3 times a year. Established diagnosis: Subacute Lombosciatica on the right of vertebrogenic
origin, persistent moderate algal syndrome; static and walking disorders; obesity grade I. The value of the
algal syndrome tested according to the VAS scale was evaluated by the patient with 9-10 points. Signs of
elongation: The Lasegue and Wassermann-Matskevich tests were positively appreciated on the right.
Functional testing according to the Oswestry Disability Index Questionnaire [1] was scored by 4 points, finger-
soil test = -23cm, Șober test = 10/12 cm. Quality of life was assessed by 56 points after the Short-Form
Questionnaire [1].
Results
The patient received drug treatment and conventional rehabilitation therapy (kinetotherapy, electotherapy) in
combination with dry cupping therapy along the path of the lumbar paravertebral musculature. After 6 weeks
from the beginning of the treatment the pain was noted with 2-3 points. The value of the Oswestry Disability
Index Questionnaire reached 1 point. Lasegue and Wassermann- Matskevich tests - negative bilateral, finger-
sol test = -4cm, Șober test = 10/15 cm. The summary value of the quality of life indices increased to 89 points
(Short-Form questionnaire)
Conclusions
The complex medical rehabilitation program associated with cupping therapy has greatly improved the
functional status and quality of life of the person with lumbar algal syndrome.Cupping therapy can be a part
of complex physiofunctional rehabilitation programs.
Key words: lumbar algal syndrome, quality of life, cupping therapy
Rferences
1.Durerea Lombară la adult. http://crdm.md/images/ups/protocol/pdf.2013
2.http://www.cnaa.md/files/theses/2019/55228/florentina cristea thesis.pdf
3.https://www.ncbi.nlm.nih.gov/pubmed/29436369
5.http://89.32.227.76/ files/14507-PCN-Durerea%2520lombar%25C4%2583.pdf
L20
L21 - PATHOPHISIOLOGY OF ENDOTHELIAL DYSFUNCTION IN
SYSTEMIC SCLEROSIS
Mihaiela CHICU

University of Medicine and Pharmacy U.M.F. “Gr.T. Popa” Iasi, Clinical Emergency County Hospital “Sf. Spiridon” Iasi
Abstract.
Introduction
Endothelial dysfunction and vascular injury are the initial events in the pathogenesis of systemic sclerosis,
determining structural changes: initialy reversible, in time they become irreversible with the obliteration of
small and medium vessels and activation of the coagulation cascade. Reducing of the vascular bed causes
focal ischemia (amplified by oxidative stress), simultaneously activating immune response and fibrogenesis.
In the early stages of the disease vasculopathy precede fibrosis, suggesting that endothelial cells are the
primary target and interact with other immune cells, the coagulation cascade, the smooth muscle cells, with
fibroblasts.
Discussions
The small arterioles and microcirculation are diffuse affected, leading to the activation of endothelial cells,
increased expression of adhesion molecules, endothelial cell apoptosis, capillaries necrosis, intimal
proliferation, intestinal obstruction.
Vascular dysfunction is the consequence of altering the balance between vasoconstrictor substances
(endothelin), and vasodilators (NO). Endothelin-1 (ET-1) has two receptors: ET-A and ET-B. ET-A receptors
is significantly decreased, while the ET-B receptor is significantly increased in patients with pulmonary
fibrosis and systemic sclerosis.
Increased levels of ET-1 have been associated with sclerodermic renal crisis, pulmonary fibrosis, the severity
of Raynaud's phenomena, the right ventricular failure.
The involvement of ET-1 in the pathogenesis of scleroderma is supported by the treatment effectiveness of
antagonists receptors of ET-1: RAPIDS-1 and RAPIDS-2. The benefit of treatment with ET-1 antagonists have
also led to their approval for the treatment of pulmonary arterial hypertension.
NO - released under the action of nitric oxide synthase by macrophages, smooth muscle cells, fibroblasts -
known as an inductor of endothelium dependent vasodilatation, has a high level in systemic sclerosis,
suggesting that there is an aberrant regulation of NO-dependent relaxation in scleroderma.
Conclusion
Defining vascular biomarkers could serve to predict vascular complications. So far none of the markers
(angiostatin, endostatin, trombospondin) have been shown solids phenotype correlations.
Keywords: endothelial dysfunction, ET-1, ET-2.
L21
L22 - Evaluation of the effectiveness of the Rehabilitation program in patients with
Lumbar Spinal Stenosis after Laminectomy
Anisoara CIMIL1
Corresponding author: Anisoara CIMIL, email: cimil.anisoara@gmail.com

1. ,,Nicolae Testemitanu,, University of Medicine and Pharmacy, Kishinev, Republic of Moldova
Abstract
Introduction. Lumbar spinal stenosis (LSS) represents one of the major causes of disability,
musculoskeletal pain and stiffness, outcomes that generate consequences such as activity and participation
restrictions with negative impact on quality of life. The application of the Rehabilitation programs
contributes significantly to the Management of LSS after the laminectomy intervention, having the
objectives of improving the functionality and quality of life of these patients. In order to evaluate the
effectiveness of the Rehabilitation programs from the point of view of the key parameters, the success of the
treatment was quantified according to the patient centered results.
Materials and Methods. We evaluated the efficacy of rehabilitation program in patients after
decompression surgery intervened by laminectomy, which was performed in the orthopedic surgery
department of the Emergency Institute from Chisinau. The study included 42 patients diagnosed with LSS
and surgery by laminectomy, divided into 2 groups, depending on the early rehabilitation in the
postoperative period. The evaluation of the results was performed in the immediate postoperative period and
after provided rehabilitation treatment was tested according to the Health Guides System of the rehabilitation
activities: Oswestry Disability Index, Roland Morris Disability Scale and Likert scale pre- and post-therapy.
Results. Scales scores correlated with change scores for pain (r = 0.32, P < 0.004) and RM (r =0.56, P =
0.009). 72 % of patients had a successful outcome according to Scales; 55%, according to global outcome;
39%, according to the RM score change, and 44%, according to the pain score change. The group who
underwent complexity rehabilitation treatment (postisomeric relaxation, ultrasound, laser, or electrical nerve
stimulation at patients) at a late postoperative period had worse scores that the group who started the
treatment in precocious period and their performance-based measure (P<.001).
Conclusions. Our results confirm that early involvement and according to the complexity of the
rehabilitation program should be considered a treatment for lumbar spinal stenosis after laminectomy as well
as a prognostic factor. The effectiveness of Rehabilitation Programs in precocious period of LSS was proved
wright through prism key parameters, which demonstrates the achievement of important undetected goals by
fixed-item measures and is a valid and sensitive outcome measure for assessing the success of rehabilitation
in patients after laminectomy.
Key words: lumbar spinal stenosis, laminectomy, effectiveness, rehabilitation.
L22
L23 - MULTIDISCIPLINARY APPROACH TO BREAST CANCER
Pâslaru Ana-Maria1 , Fătu Ana-Maria2, Munteanu Iulian3, Verenca Mădălină Codruța2, Ciubară
Anamaria4
Corresponding author: Ana-Maria Fătu, E-mail: anafatu09@gmail.com
Department Oncology, Emergency Clinical Hospital for Children "Sf.Ioan", Galati, Romania.
1
2
Department Recovery, Physical Medicine and Balneology, Emergency Clinical Hospital for Children "Sf.Ioan", Galati, Romania.
3
Departament Ginecology, Emergency Clinical Hospital "Sf. Apostol Andrei", Galaţi, Romania.
4
Department of Psychiatry, Psychiatry Hospital "Elisabeta Doamna", Galaţi, Romania.
Abstract.
Introduction.
Breast cancer is the most common neoplasia found in women both in developed and developing world. Despite
the existence of screening programs the incidence of this disease is increasing from year to year. Early
diagnosis of the disease offers the chance for a long survival.
Material and method.

Analysis of statistical data shows that in most cases this disease is diagnosed at advanced stages, when
important medical interventions are needed. Treatment of breast cancer requires careful examination of major
therapeutic options which may include surgery, radiotherapy and systemic therapy. The radical mastectomy
is a big surgical intervention, of both physically and mentally point of view. Depending on the stage of the
disease and the extent of the surgical intervention some patients may need post-mastectomy lymphatic
drainage. Its purpose is to prevent or treat the arm lymphedema. Kinetotherapy, manual therapy and other
physiotherapy techniques are recommended before breast reconstruction for tissue elasticity and joint
mobility.

Medical recovery after the oncology disease diagnosis is part of the treatment The challenge during the
treatment of oncological patients consists of the necessity to address to patients with different infirmity grades.
Conclusions.
The development of a long-term multidisciplinary management plan offers the patients the possibility of
maintaining their functionality and an improvement in the symptomatology caused by anti-neoplastic
treatment.
Key words: physical exercise, treatment, breast cancer
L23
L24 - The Influence of Environmental Factors on People with Musculoskeletal Disorders
Dumitru MIHĂILĂ¹, Sinziana-Calina SILISTEANU ², Mihaela (Ciurlică) ȚICULEANU¹
Corresponding author: Sinziana-Calina SILISTEANU, E-mail: sinzi_silisteanu@yahoo.com
1. Geography Departement, USV, Romania

2. Specliatility Ambulatory Division CF Suceava, FEFS-DSDU USV, Romania
Abstract
Introduction. Human health is dependent on the variability of meteorological factors, of meteorological

elements (sun radiation, atmospheric pressure, ambient temperature, humidity, wind, etc.) but also on the
worsening of the chemical composition of the atmosphere. The sudden changes of the weather conditions, the
increase in the intensity of the sun rays over certain levels, the atmospheric pollution, are risk factors that must
be acknowledged in order to maintain an optimal state of health among the population of Suceava town.
The general objective of the study is the evaluation of the impact for some of the meteorological factors and
elements on the people with diseases of the myo-arthro-kinetic apparatus.
Materials and methods. For a period of 6 months, the health condition, and the reaction of the body of the
patients who came to the medical recovery office was monitored, according to the values of certain
meteorological elements. The data were obtained after several questionnaires applied to patients at the first
examination and after the recovery treatment, and then statistically processed.
Results. The analysis of the data over a period of 6 months shows the increase in the addressability of the
people with musculoskeletal symptoms in the periods when large amplitudes of temperature, pressure and
relative humidity were manifested. Also, due to the pollution and the worsening of the air composition, the
percentage of oxygen in the air has slightly decreased, while increasing the one of carbon dioxide, with an
impact on the activity of other devices (respiratory, cardiovascular) with consequences for short, medium and
long periods on human health. These affected systems have influenced the evolution of the musculoskeletal
diseases.
Conclusions. By exposing patients to the variability of atmospheric factors, the evolution of certain conditions
may be accelerated or aggravated, with an impact on the patients’ health condition. In this context, not only
the musculoskeletal system is affected but also the action of the environmental factors is found in all the organs
of the human body, affecting the clinical-functional status of the patient.
Keywords: musculoskeletal disorders, atmospheric factors, health status
L24
L25 - Efectele tapingului biomecanic Dynamic Tape© în vederea creșterii
controlului stabilității la genunchiul post-traumatic.
Ilie Eva; Luca Mirela; Vasilescu Toma
Abstract.
Taping biomecanic, stabilitate, modificarea mișcării, absorția sarcinii mecanice;
Scopul Studiului:
Demonstrarea efectelor pozitive asupra stabilității controlate în timpul flexiei genunchiului în lanț cinematic
închis, folosind tapingul biomecanic Dynamic Tape©.
Abordarea tapingului biomecanic poate îmbunătăți controlul stabilității la nivelul genunchiului post-traumatic
prin mecanisme ce asistă mișcarea pe toată amplitudinea sa, prin absorția sarcinii mecanice și prin decelerarea
în fază excentrică?
Metode:
În perioada 08/03/2018 – 15/05/2018, 13 pacienți au fost incluși în acest studiu cu patologii la nivelul
articulației genunchiului. Studiul fiind unul intervențional, controlat aleatoriu (Randomized Controled Trials,
RCTs), Single Blind, pacienții fiind în timpul programului de recuperare în 3 clinici private din România:
București, Craiova, Iași. Din lotul de 13 pacienți, 5 au fost de sex feminin și 8 de sex masculin. Media de
vârstă 27.46 ani (min 14 ani – max 44 ani). Distribuția patologiei la nivelul membrelor a fost de 5 pacienți cu
membrul inferior stâng traumatizat, iar 8 pacienți cu membrul inferior drept.
Din lotul de studiu, 1 pacient a avut tendinopatie rotuliană, 1 pacient a avut luxație la nivelul patellei, 1 pacient
meniscectomie la nivelul meniscului intern, 2 pacienți reconstrucție la nivelul ligamentului încrucișat anterior.
Restul de 8 pacienți au avut o patologie mixtă: 4 pacienți ligamentoplastie(ACLR) + meniscectomie (M.I.), 1
pacient ligamentoplastie (ACLR) + ruptura ligamentului medio-patelofemural (MPFL), 1 pacient
ligamentoplastie (ACLR) + meniscectomie (M.I. + M.E), 1 pacient ligamentoplastie (ACLR) + meniscectomie
(M.I. + M.E) + condropatie gr 3 operată, 1 pacient ligamentoplastie (ACLR) + meniscectomie (M.I.) +
condropatie gr 3 operată.
Pentru a afla eficiența tapingului biomecanic privind stabilitatea controlată la nivelul articulației genunchiului,
am folosit ca metodă de evaluare Single Leg Squat Test (SLST) pentru a măsura distanța în timpul flexiei pe
membrul operat. Lotul de pacienți a efectuat SLST de 3 ori, împărțit aleator, Seria 1 – NO TAPE (NT), Seria
2 – Control Group (CG), Seria 3 – Dynamic Tape© Group (DTG). Aplicările și măsurătorile s-au efectuat în
aceeași zi, ordinea seriilor de lucru fiind „random”.
SLST s-a realizat prin stabilirea unei poziții de start (la nivelul degetelor), pacienții realizând mișcarea de
genuflexiune cu membrul inferior post-traumatic, cel neafectaat fiind întins spre înainte. Măsurătoarea s-a
realizat în centimetri, orice mișcare în care pacientul atingea podeaua cu membrul neafectat sau genunchiul
post-traumatic intra în valg dinamic, măsuratoarea nu era luată în considerare.
Rezultate:
În urma colectării datelor, media distanței parcurse în timpul SLST a lotului de studiu a fost de 43,048 cm în
timpul testărilor inițiale fără tape(NT), 45,698 cm în cadrul aplicării în poziție alungita a membrului inferior
(CG) și 47,771 cm în timpul aplicării biomecanice, în poziție scurtată (DTG).
L25
L26 - Osteoporosis - therapeutic chalenge?
Liliana Elena Stanciu¹, Elena Valentina Ionescu¹²,Daniela Profir¹, Elena Roxana Almasan¹, Marius
Sorin Chiriac¹
Corresponding author: Liliana Elena Stanciu, E-mail: chiriacsorin2002@yahoo.co.uk
1
Balneal and Rehabilitation Sanatorium Techirghiol, Techirghiol, Romania
2
„Ovidius” University of Constanta, Faculty of Medicine, Constanta, Romania
Abstract
Introduction: Osteoporosis is a disease of the entire skeleton, characterized by decrease bone mass and
microarhitectural alterations of bone tissue, which result in increased bone fragility and predisposition to bone
fractures.
Material and method: Accesing standard medical databases: Medline, Embase, Database, Pubmed and the
Cochrane Register of Controled Studies to review new pharmacological studies and non-pharmacological
terapies in osteoporosis. Statistical analysis performed from the data extracted from the observation sheets
from June 2019 to December 2020 by Dr. Liliana Stanciu.
Results and discussion: The complex balneo-physical-kinetic treatment is an important link in the treatment
of the disabling pathology for the patient, with an important clinical resonance. Modern physiotherapy in this
pathology: Vacu Sport, Power Plate.
Conclusion: Osteoporosis is a pathology that decreases the patient’s quality of life. There are complementary
therapies to pharmacological treatment with immediate and long lasting results.
Keywords: mud, osteoporosis, balneal, hormones
L26
L27 - ASSISTIVE SENSORY REHABILITATION DEVICE FOR HAND
HYPOESTHESIA
Robert Fuior, Cătălin Ioniţe, Daniela Viorelia Matei, Călin Corciovă
Corresponding author: Robert Fuior, E-mail: fuior.robert@gmail.com ,

University of Medicine and Pharmacy “Grigore T. Popa”, Str. Universitatii 16, Iasi, Romania
Abstract.
Introduction. Paresthesia is a neurological condition in which the affected person perceives normal stimuli
in a pathological way, such as tingling or numbness. The complete lack of neural transmission defines
anesthesia, which is clinically less frequently observed. Hypoesthesia implies a partial loss of sensitivity to
stimuli. This may occur in any area of the body, but more commonly the extremities are affected, ie the hands,
legs and fingers of the hands and feet. When associated symptoms such as needles, bruises or burning
sensations are present, in absence of stimuli, it is called dysesthesia. Paralysis means loss of muscle function,
but if the damage involves motor and sensitive fibers, it associates loss of sensitivity.
Material and method. This paper has been conducted on a total of 10 patients who had lost tactile sensitivity,
due to different pathologies. The patients performed a recovery program for 10 days by following a trail with
the affected hand on a sensory carpet equipped with a series of pressure sensors that were connected to an
Arduino development platform which returns the data from sensors. This sensory carpet records the pressure
exerted by the patient, as well as the time required to recognize the material and its roughness. All recorded
data has been collected and processed using a software (Fig.1).
Results and discussions. After comparing and processing the data, the results indicated that the initial pressure
exerted for material recognition and its roughness decreased considerably as the treatment progressed.
Moreover, the time required to recognize the material and its texture had dropped considerably.
Conclusions. Based on the present results, it can be inferred that the use of the sensory carpet helps track
tactile improvements in patients with hand hypoesthesia by using a rehabilitation device. The statistical
evaluation brought a qualitative contribution to the work by processing the obtained results and increasing the
significance of the presented data.
Key words: statistical processing, sensory carpet, touch tactile, rehabilitation, pressure sensors,
Fig. 1 Device block diagram
L27
L28 - Comparative Evaluation of Balneological Influence of Hydromineral Resources on
a Human Body According To the Data of Blood Biochemical Indicators
Elena KORNILOVA1, Traian-Virgiliu SURDU2,3, Nikolay KORNILOV1, Olga SURDU3,

Monica SURDU2
Corresponding author: Traian-Virgiliu SURDU, E-mail address: traian@surdu.ro
1. North-Caucasian Social Institute, Stavropol, Russia

2. Ovidius University of Constanta; Romania
3. Balneal and Rehabilitation Sanatorium of Techirghiol, Constanta Country, Romania
Abstract
Introduction. The aim of the work is to develop an algorithm for calculating the functional dependences of
changes in the characteristic blood parameters of patients before and after the balneological procedures
according to biochemical blood tests. Currently, methods of IT technologies are being actively developed to
establish functional dependences of the physiological state of the human body on the composition and
properties of blood during diagnosis, development of a course of treatment and rehabilitation
recommendations for the subsequent recovery period.
Materials and Methods. The chemical composition of venous blood was studied in a group of patients in
the amount of 30 people before and after the balneological procedures using sapropelic therapeutic mud of
Lake Techirghiol (Romania). Samples were studied on a CCCXC-6 Nova Biomedical instrument (Austria).
The dependences of changes in the composition and properties of the blood of patients were calculated
according to the method of mathematical modeling of the composition of Eurasian natural mineral waters,
developed by Vasiltseva O.N., Kornilov N.I. and Kornilova E.N.
Results. The effectiveness of treatment and subsequent monitoring of the physiological state of the patient's
body were evaluated by the equation:
logφ=logα-δlog⁡(x_i⁄x_j ) (1), where: φ is a characteristic indicator of the composition and properties of
venous blood; x_i⁄x_j - the ratio of the studied biochemical blood parameters; logα and δ are constant values
characterizing the measured blood indicator.
The following blood parameters were selected: the content of ions 〖Cl〗^- and 〖HCO〗_3^-, mol/dm3,
respectively x_i and x_j; hemoglobin, g/dm3; glucose, g/dm3; oxygen and carbon dioxide, mm Hg; the value
of the acid-base state, in units pH.
Calculation of blood parameters according to equation (1) showed that the effect of sapropelic mud on the
patient's body is accompanied by a decrease in the blood ions 〖HCO〗_3^- - ions and an increase in the
concentration of ions 〖Cl〗^-, the pH value shifts to the region of higher alkalinity values. Blood saturation
with oxygen after mud therapy procedures increases, which leads to an increase in hemoglobin and a
decrease in glucose in the blood of patients.
Conclusions. Thus, we can conclude about the intensification of metabolic processes in the human body
after a course of mud therapy. The use of computer diagnostics using characteristic blood parameters φ
allows us to quantify the effectiveness of the recommended balneological procedures.
Keywords: peloidotherapy, blood ions, mathematical modeling, characteristic indicator
L28
L29 - Study on the Influence of the Anxiety State for the Elderly Diagnosed with Knee
Osteoarthritis
Sinziana Calina SILISTEANU¹, Andrei Emanuel SILISTEANU²

Corresponding author: Sinziana SILISTEANU, E-mail address: sinzi_silisteanu@yahoo.com
1. Railway Hospital Iasi - Specialty Ambulatory of Suceava - "Stefan cel Mare" University of Suceava, Romania
2. Cluj School of Public Health - FSPAC - ‫”܈‬Babes-Bolyai” University, Romania
Abstract
Introduction. The knee osteoarthritis affects about 250 million people worldwide, and 10-20% of the
persons over 60, requiring great costs for the family, society and economy. It is a cause of chronic disability
at the joints, and it is more frequent in hips, knees, hands and backbone. The disability and the pain can be
reduced by having a healthy life style, a body weight adequate to the age.
Some elderly persons diagnosed with knee osteoarthritis may feel anxious or severely depressed. The
anxiety is associated to the increase in the sensitivity to pain. The recovery involves pharmaceutical therapy
and kinesio-therapy in order to reduce the algic phenomenon and to improve the physical and psychical
function.
The purpose of this study was to prove the relation between the anxiety state and the phenomena
determined by the knee osteoarthritis for the elderly.
Materials and Methods. There were 56 patients, over 60 years old, diagnosed with knee osteoarthritis,
whose functional and cognitive status was assessed before the recovery program and after that. It was done 3
times a week for 30 minutes, for a period of 20 days, in the ambulatory unit. The patients were assessed for
pain (VAS scale and WOMAC subscale), joint stiffness and functional capacity (WOMAC subscale),
quality of life (QOL scale) and anxiety state (anxiety test).
Results. At the end of the treatment, it was found that the pain was reduced, the joint stiffness was decreased
whereas the functional status was improved. The quality of life was better, the nutritional state improved
whereas the anxiety was reduced.
Conclusions. The individual recovery program has an important role in addition to a diet with the purpose of
reducing significantly the pain, the joint stiffness and the body weight index. Moreover, it determined the
increase in the mobility and stability of the knee joint, and implicitly the anxiety of these patients lessened.
L29
L30 - The impact of saprogenic mud from Techirghiol lake on oxidative stress in ankylosing spondylitis
Daniela Profir¹, Viorica Marin¹, Traian Virgiliu Surdu²
Corresponding author: Daniela Profir, E-mail: profir_daniela@yahoo.com
¹ Balnear and Rehabilitation Sanatorium from Techirghiol

² ”Ovidius” University Constanta, Faculty of Medicine
Abstract
Ankylosing spondylitis (AS) is a complex disease, potentially debilitating, with an insidious onset and
radiologic progression of sacroileitis after several years, having as consequences loss of working capacity
because of invalidity, damage of health resources and of life quality. Pathogenesis of this condition is not
completely elucidated. Yet immune mediated mechanisms involving human leucocyte antigen HLAB-27,
cellular inflammatory infiltrations, proinflammatory cytokines, as tumor necrosis factor TNF-α and
interleukin-10, as well as genetic and environment factors are playing an important role.
That’s why these days we are witnessing a process of approaching to natural therapeutic factors, as helping
therapy for many of the diseases for which modern medicine hasn’t yet any remedy. Balneotherapy, no matter
of the origin and composition of the natural factors used, has a holistic impact upon entire human body.
The study conducted in the sanatorium upon a group of patients with AS between 2012-2013 tried to
demosntrate one of the backgrounds of the therapeutic effects of saprogenic mud – improvement of oxidative
stress after therapeutical application of mud and salted water from the Techirghiol Lake. In order to elucidate
the complex mechanisms of mud action, respecting the criteria of evidence-based medicine, one of the
proposed objectives was evaluation of antiinflammatory effect of mud in patients with AS by determining
some markers of oxidative stress in dynamics, considering the fact that there is a strong correlation between
initiation of inflammatory process and reactive oxygen species. The following markers were measured: total
anti-oxidative status (TAS), superoxide dismutase (SOD), glutathione reductase (GR), reduced glutathione
(G-SH).
The results have shown once again the invaluable therapeutic potential of sapropelic mud from Techirghiol,
as helpful therapy in chronic inflammatory rheumatism.
Key words: ankylosing spondylitis, proinflammatory citokines, oxidative stress, sapropelic mud.
L30
L31 - The INTERDISCIPLINARY TREATMENT of LUMBAR DISC HERNIA on a
PATIENT with CORTICOTERAPY DEPENDENCY and HISTORY of LYMPH NODE TB
A.A. TOMA ¹ˑ², I.B. GHINGULEAC², L.A. GHINGULEAC², L.E. STANCIU²ˑ³, E.V. IONESCU²ˑ³
1. „Ovidius” University of Constanta, Romania

2. St. Andrew Emergency Hospital of Constanta, Romania
3. Balneal and Rehabilitation Sanatorium of Techirghiol, Constanta, Romania
Abstract
Introduction. Disc herniation means the movement of an intervertebral disc. HDL (lumbar disc herniation)
is an evolutionary phase of lumbar vertebral discopathy (DVL)
DVL Seze Classification:
Phase I: low back pain
Phase II: lumbar pain and paravertebral contracture
Phase III with four stages from: radicular pain to discartrosis
Materials and Methods. We are presenting the situation of a female patient, aged 62, from the urban area,
with confirmed vices of smoking and sedentary lifestyle, which presented in Emergency room in Constanta
for lumbosciatalgias and paresthesias, impaired walking and presence of antalgic positions that required
hospitalization in Neurosurgery section. The patient has a 15 points Glasgow score is known to have
Hypertension, PR, minor stroke and lymph node Tuberculosis (TB).
The muscular and osteoarticular system: apparently integral and difficult to mobilize.
The MRI examination reveals 2 lumbar disc L4 level hernias. The neurosurgical treatment was applied:
Discectomy in the L4 disc herniation bilaterally with the removal of the disc fragments. Subsequently, the
patient was transferred to the medical recovery department. The patient was evaluated clinically,
functionally in dynamics to track the effectiveness of the neuromotor rehabilitation program.
Results. Through the program of early recovery established, the therapeutic yield was significant with the
improvement of the clinical symptomatology as well as the marked increase of the functional parameters,
assuring the patient a high degree of mobility, of autonomy, but also of reintegration in the social and family
life.
Conclusions. The peculiarity of this case was the critical condition of the patient at the hospitalization,
corticodependence, which makes the surgery but also the medical rehabilitation much complicated by
functional osteoporosis and low bone consistency. Neurosurgery together with medical rehabilitation have
sounded excellent together with in many cases the ability to restore strength, functionality as well as better
health of patients, which creates an indispensability between the two specializations.
Keywords: Disc herniation, Neurosurgery, Rehabilitation
L31
L32 - Study on the correlation between knee osteoarthritis and anxiety in patients aged over 55
DUICA Lavinia1,2, SZAKÁCS Juliánna3 , SILIȘTEANU Sînziana Călina4,5
Corresponding author: Sinziana Silisteanu, E-mail: sinzi_silisteanu@yahoo.com
1 Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România
2 Hospital of Psychiatry „Doctor Gheorghe Preda” Sibiu, Romania
3 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of
Medicine, Department of Biophysics
4 Railway Hospital Iasi - Specialty Ambulatory of Suceava
5 "Stefan cel Mare" University of Suceava FEFS-DSDU
Abstract
Introduction. Osteoarthritis, which is a cause of chronic pain and disability with manifestation in any joint,
with greater frequency in the joints of the lower limbs, upper limbs, but also at the spine level , affects
around 250 million people in the entire world. This condition affects around 10% of the global population
(18) and has an impressive impact on people, as it is one of the first 5 causes of disability.
Material and method. The objectives of the treatment made by the patients diagnosed with knee
osteoarthritis were: pain reduction, increased joint amplitude, increased muscle strength, increased muscle
tone, increased quality of life and reintegration into the family and social environment. In the study, there
were discussed demographic data regarding the patients. In order to assess the pain parameter, the VAS scale
was used, as well as WOMAC subscales. To assess the quality of life of patients with knee osteoarthritis, the
QOL scale (Quality of Life) was used. Anxiety was assessed with the help of a test that comprises the
evaluation of symptoms at the cognitive, behavioral and physical level.
Results and discussions. The pain was evaluated on the VAS scale, having a statistically significant
evolution for the evaluation moments. Also with the help of the WOMAC index, two other parameters were
evaluated, namely joint rigidity and functional capacity, the results being statistically significant in the 3
evaluation moments. The patients’ anxiety was evaluated with the help of the anxiety test; the results
obtained were statistically significant at the 3 evaluation moments.
Conclusions. It is vital that the recovery treatment in osteoarthritis be individualized and adapted to the age
group. In our group, it enabled the reduction of pain and anxiety, the increase of the functional capacity and
the quality of the patients’ lives.Taking into account the fact that the most affected group in the study group
was the active professional one, we can evaluate the size of the recovery and the social, family and
professional integration for these patients.
Key words: knee osteoarthritis, the quality of life, anxiety, kinetotherapy,
L32
L33 - The Importance of Early Respiratory Rehabilitation in Patients with Duchenne
Muscular Dystrophy
Liliana VLĂDĂREANU1, Monica Iolanda NEDELEA 1, Ana-Maria IFRIM 1
Corresponding author: Liliana VLĂDĂREANU, E-mail: vladareanuanamaria@yahoo.com

1. Techirghiol Rehabilitation and Balneal Sanatorium, Children’s Neurorehabilitation Ward
Abstract
Introduction. This article was written as an attempt to emphasize the important role that respiratory
rehabilitation holds as a mean to ensure better quality of life and better life expectancy for Duchenne Muscular
Dystrophy patients. As new groups of targeted medication are being developed, we are now witnessing longer
life spans for patients even in developing countries such as Romania and thus the need for better physical care
and better respiratory management.
Materials and Methods. We have tried to group together some of the most important guidelines in the field
and to get an image of how complex the team managing these patients is and also to give the auditorium an
insight of the team work being done in our unit in order to meet as many as possible of the requirements listed
in the guidelines.
Key words: Duchenne Muscular Dystrophy, respiratory rehabilitation, guidelines of care, rehabilitation
team.
L33
L34 - MUVON PLUS – Adjuvant in Osteoarticular Pain Therapy
(Study)
Adriana LUPU
Corresponding author: Adriana LUPU
1. Faculty of Medicine and Pharmacy of Galaţi
Abstract
Introduction. As an interface between the external and the internal medium, the osteoarticular system is
vulnerable to both the bodily imbalances and the experiences accumulated throughout life.
The factors that might affect osteoarticular health include: nutritional deficiencies, certain drug therapies,
hormonal imbalances, obesity, chronic diseases, genetic factors, vicious positions, accidents etc.
All these factors facilitate or worsen the disease generically called arthrosis, a degenerative disease that
manifests by the decay of the joint cartilage which, further to the reduction of the synovial liquid production,
progressively becomes thinner until its destruction. Consequently, in the absence of the cartilage protection,
tendons and ligaments become more tense and, by the time the disease has progressed, the cartilage is
completed deteriorated, and a friction process intervenes within the joint, entailing painful consequences and
restrictive movement.
Topic motivation and objectives. We have the tendency to associate osteoarticular diseases with the elders,
but, under certain circumstances, the disease may involve any person regardless of age. That is why, the
motivation of approaching this study’s topic consists in exposing certain remarks in regard to the
complementary therapy of the pains caused by the joint cartilage microlesions, within which the
administration of nutritional supplements might represent an adjuvant to allopathic therapy.
Materials and Methods. The study unfolded throughout 3 months and included 30 patients with pains
mainly within the coxofemoral and knee joints, who were recommended the MUVON PLUS nutritional
supplement.
The patients underwent an initial assessment at the beginning of the study through a questionnaire on pain
and how it affects their daily activities, as well as the VAS scale, which was applied at the end of the study
in order to acknowledge therapy’s effects.
Results. The initial pain overview of the 30 patients and the therapy results are as follows:
- Mild initial pain– 9 (namely 30% of the lot) that disappears at the end of the therapy;
- Moderate pain – 14 (46.67%), whereby the pain disappears in 9 patients;
- Severe pain– 7 (23.33%) with severely affected mobility, moving by means of the walker or
companion; at the end of the therapy, 5 patients had mild pain and 2 patients moderate pain.
Conclusions. At the end of the MUVON PLUS therapy, as adjuvant to allopathic treatment, the patients of
the studied lot displayed an improvement of their general physical-psychic condition further to the reduction
or even disappearance of pain, as well as further to mobility improvement.
Key words: arthrosis, degenerative disease, pain, mobility, food supplement, MUVON PLUS.
L34
L35 - A Rehabilitation System Based on Internet of Things (IoT)
Călin Corciovă1, Doru Andriţoi, Robert Fuior1, Cătălina Luca1
Corresponding author: Călin Corciovă, E-mail: calin.corciova@bioinginerie.ro
1. Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
Abstract.
Introduction Internet of things (IoT) is a contemporary technology with the potential to alter or replace the
various methods of classical medicine and improve healthcare. The advantage of measuring physical
parameters using IoT devices instead of conventional ones is that the connected intelligent IoT devices can
carry out measurements independently, and carry out a specific action based on the measurement results. Also,
the results of measurements are available via Internet and can be recorded in electronic form, enabling medical
personnel to monitor patient’s state from any location at any time. Medical rehabilitation institutions are
usually limited in space and personnel, so patients are forced to continue practicing physical therapy at home.
IoT-based systems allow for the implementation of effective physical therapy from a distance and provide
insight into the recovery process of competent medical personnel from a remote location and will provide
therapist interaction with the patient through communication technologies.
Material and method The proposed IoT-based system architecture is configured into two segments: a home
part and a cloud based software as a management part. The home part requires the installation and
configuration in the patient's living environment of components such as the body tracking sensor, the Kinect
and muscle sensor. Software as a cloud management segment serves several purposes: it offers software for
rehabilitation therapy; collects and analyzes data and represents them in comparative and progressive form;
allows medical staff to remotely track the patient's condition and manage additional therapies.
Results and discussions The results of the pilot rehabilitation session after two weeks using a serious game
showed significant improvements in rehabilitation. After the trial, the patients presented increased
concentration, faster reflexes and greater mobility of the affected hand.
Conclusions The system developed for research can serve as a basis for implementing a system that will be
used widely in post stroke rehabilitation and assessment of the recovery.
Fig. 1. Block diagram of IoT system rehabilitation
References:
[1]. Y. Jog, A. Sharma, K. Mhatre, A. Abhishek, Internet of Things as a Solution enabler in health sector, International Journal of
Bio-Science & Bio-Technology, Vol. 7, No. 2, pp. 9-24, 2015.
[2]. D. Webster, O. Celik, Systematic review of Kinect applications in elderly care and stroke rehabilitation, Journal of
Neuroeneering and Rehabilitation, Vol. 11, No. 1, 108, pp. 1-24, 2014.
[3]. O. Erazo, J. Pino, R. Pino, C. Fernandez, Magic mirror for neurorehabilitation of people with upper limb dysfunction using
kinect, Proceedings of the 47th Hawaii International Conference on System Sciences (HICSS), 2014, pp. 2607-2615.
[4].Tuan Nguyen Gia, Amir Mohammad Rahmani, Tenhunen, H., Fault Tolerant and Scalable IoT-based Architecture for Health
Monitoring. In: IEEE Access 2015.
L35
L36 - UVEITIS – POSSIBLE ADVERSE REACTION TO SECUKINUMAB IN A PATIENT WITH
ANKYLOSING SPONDYLITIS (case report)
D. Oprea1,2 , M. Zamfirescu2,3, D. Jimbu3, E. V. Ionescu1,2, C. Oprea1,2, M. G. Iliescu1,2
Corresponding author: Doinița Oprea, E-mail: doi_opr@yahoo.com
1
2
3
Clinical Emergency Hospital Constanta County, Constanta, Romania
Abstract
Introduction
Ankylosing spodilitis (SA) is a chronic inflammatory disease that predominantly affects the spine, but also
peripheral joints, the major feature of the disease being the early involvement of the sacroiliac joint.
The most common extraskeletal manifestations are ocular disorders and appear to 25-30% of the pacients,
being more frequent to HLA B27 positive patients. Episodes of previous acute uveitis, known iridocyclitis,
may precede or may occur during or after inflammatory joint manifestations.
Matherials and Methods
We present a 41-year-old patient diagnosed 11 years ago with ankylosing spodilitis , axial form, without
extra-articular manifestations, periodicaly treated with antiinflamtory drugs and balneary treatment, but with
inneficient clinic and biological response. Since november 2019 his treatment with Secukinumab, started to
improve the clinic and paraclinic symptoms. Secukinumab is a fully human monoclonal antibody, the first
care that selectively targets IL-17A, an essential cytokine treatment that produces inflammation, and bone
remodeling, characteristic of SA.
Results
In January 2020, the patient presents increased pain and redness in the right eye area, subsequently diagnosed
as anterior acute uveitis.
Conclusions
This anterior acute uveitis, may be a extra-articularly manifestation in the context of the natural evolution of
the disease insufficiently controlled by the recently introduced therapy, or it may be an adverse reaction to
Secukinumab, being known that the optic misfunction is a less common side effect.
Keywords: ankylosing spondylitis, uveitis, Secukinumab
L36
L37 - LOW DUTY-CYCLE ULTRASOUND APPLICATION FOR PHYSICAL THERAPY
COMPLEX PROGRAM ON THE RECOVERY OF CALCANEAL SPURS
Ilie ONU12, Mariana ROTARIU1, Robert GHERGHEL2
1
University of Medicine and Pharmacy „Grigore T. Popa”, Iași, România
2
Micromedica Medical Clinic, departments of orthopedics and physiotherapy, Piatra Neamț
elipetromed@yahoo.com, rotariu29@yahoo.com , gherghelrobert@yahoo.com
Abstract.
Introduction: Calcaneal spurs are a very common reason why patients go to the medical offices. The calcaneal
spur is a bony protrusion that appears at the level of the plantar fascia, but most commonly at the insertion of
the plantar fascia on the heel. It is considered calcaneal spur from 2mm upwards, diagnosed on the profile
incidents of calcaneal radiographs. The pain is in a close relation with the size of the spur, that are being given
by the level of compression of the lower calcaneal nerve, with the inflammation of the spur, with the thinning
of the fat layer surrounding the heel and the plantar fascitis. Physical Therapy is a non-invasive treatment
method with appreciable effects in the short and medium term in reducing the symptomatology of calcaneal
spurs and help regaining the characteristics of the ankle joint mobility, bipedal station and walking.
Materials and methods: The study was carried out on 6 month time period in the Piatra Neamt Micromedica
Clinic on a group of patients diagnosed with calcaneal spurs, aged 39-67 years. The study aimed to assess the
level of pain reduction, as well as the increase of the mobility of the ankle joint after the sessions of physical
therapy. The group consisted of 60 patients diagnosed and confirmed radiologically with spurs between 5 and
20 mm. For pain assessment the VAS scale was used, being evaluated in the bipedal standing position, in
walking and resting, both before and after the physical therapy treatment. For measuring the joint mobility of
the ankle, for plantar and dorsal flexion, it was used the goniometric measurement method at the beginning
and at the end of the physical therapy treatment. Patients underwent a physical therapy treatment complex
consisting of 10% duty-cycle plantar ultrasound application, TENS, passive and active streaching, for 10
consecutive days. Eligible patients were those with VAS 5-6, who had supportive medication prior to physical
therapy treatment.
Results: The initial evaluation, was followed by another one at the end of the 10-session treatment. The
obtained results were analyzed in terms of two indicators: visual analogue scale (VAS) for pain intensity
measurement and gonimiometric tests of ankle joint mobility. The main result was decreased pain intensity
and increased joint mobility. After the completion of the 10 sessions treatment, the group of patients showed
substantial clinical improvements: the VAS decreased from 6 to 1 in both rest, biped and walking.
Conclusions: Following the analysis of pain and function, we can say that the physical therapy treatment plan
greatly reduced the symptoms and improved the function of the foot. Patients effectively described the
program from the perspective of pain relief even during the sessions.
Keywords: heel pain, calcaneal spur, physical therapy, ultrasound
L37
L38 - Pulmonary Rehabilitation in Congenital Chest Malformations – Case Report
Paraschiva POSTOLACHE1, Doina-Clementina COJOCARU1, Diana BIVOL2
Corresponding author: Paraschiva POSTOLACHE, E-mail: postpar04@yahoo.com
1. “Grigore T. Popa” University of Medicine and Pharmacy Iași, Romania

2. Regional Institute of Oncology, Iasi, Romania
Abstract
Introduction. Pectus excavatum is a congenital chest malformation that has several etiopathogenic
mechanisms: inbalanced costochondral hypertrophy, intrauterine traumatism or rahitism. This patology is
suitable for respiratory rehabilitation (RR), a complex, multidisciplinary process that addresses to all patients
with chronic pulmonary disease.
Materials and Methods. We report the case of a 43-year-old male, nonsmoker, diagnosed with pectus
excavatum by the age of 5. Sternochondroplasty was performed, but later surgical reoccurs when is
diagnosed with pulmonary cysts (lower right lobectomy).
The physical examination showed an asimetric and deformed chest, pectus excavatum, post-operative scars
in the right hemithorax, crepitant rales, SpO2=94%; the spirometry shows restrictive ventilatory disfunction;
the patient has completed the tests with an EKG, effort capacity evaluation, evaluation of dyspnea scales, the
Lawton Instrumental Activities of Daily Living, etc.
RR in patients with congenital malformations involves medical education, changing lifestyle, training the
respiratory musculature and the benefits are: improving the capacity of effort, emotional state, reducing
dyspnea, anxiety, depression, the number and severity of exacerbations and hospitalization, increasing the
quality of life and improving psycho-social reintegration.
Results. The patient underwent the RR program and benefited of respiratory kinetotherapy, respiratory
muscular training with decreasing dyspnea, expectoration and increasing effort capacity. At the evaluation of
dyspnea, the mMRC scale showed an improvement from a grade 3 to 1 and BORG scale showed an
improvement from 6 to 3. At 6-Minute Walk Test the patient showed an improvement of the effort capacity
(from 63% of walking distance on the first day of hospitalization to 80% in the last day).
Conclusions. This malformation can go unnoticed at birth, but it increases getting older, causing the
compression of intrathoracic organs. Although the patient underwent correction surgery in childhood, it
relapsed with reoccurrence of the excavation, leading to an inesthetic appearance and pulmonary function
alteration.
L38
L39 - Biological Models for Sulphurous Thermal Water Inhalation, Simulated from a
Numerical Perspective
Mariana ROTARIU1, Marius TURNEA1, Dragos AROTARIȚEI1, Iustina AVRAM1,

Corresponding author: Iustina AVRAM, E-mail: avram.iustina@yahoo.com

1. University of Medicine and Pharmacy „Grigore T. Popa”, Street University, no 16, Iași, România
Abstract
Introduction. The lungs are the target location for inhalation vapors and therefore the calculation of the total
dose absorbed in each airway during inhalation exposure is essential. Inhalation of thermal water with
antioxidant properties is used empirically for COPD (chronic obstructive pulmonary disease). Efficiency of
sulphurous mineral water in chronic rhino-sinus, eg Although high levels of hydrogen sulphide can be
extremely toxic, however, we must say that a dose pattern absorbed in each airway during inhalation exposure
is useful as a predictor of daily treatment during treatment. with sulfurous mineral water.
Materials and Methods. The existing mathematical models for vapor absorption in lungs are taken into
account in a systematic manner. Lower respiratory tract uptake of vapors versus air partition coefficients are
one of the models that is analyzed in order to describe the process by a simpler Gray-Box model. The method
is applied to prediction of lung fraction of inhaled vapors as a function of partition coefficient for hydrogen
sulfide, formaldehyde, acrolein, and acetaldehyde.
Results. The experimental results showed a good fit of data with the mathematical formula, the rooted mean
square error below 5% in most of the case, and a prediction with an error below 1% in the case of curves
obtained by PBPK model obtained by solving numerically the system of differential equations.
Conclusions. Alternative to pharmacokinetic, mathematical formulas discovered by mathematic black-box
approach can be used to predict sulphite absorption and excretion or vapor uptake in the lung. The
disadvantage of lack of connection with physiological phenomenon is compensate when it is necessary a
simple mechanism for prediction based on experimental data and the modelling process based on physical and
chemical assumptions is very complicated or it is not completely elucidated.
Key words: pulmonary vapor absorption, mathematical models, inhalation dosimetry, numerical simulation.
L39
L40 - "Eppur si muove" - Clinical case: evolutionary "saga" during the last 6 years: posttraumatic
subdural hematoma, decompressive craniectomy, right hemiplegia and aphasia, cranioplasty,
hydrocephalus and porencephaly, post-traumatic encephalopathy - in remission.
Aurelian Anghelescu1,2 Anca Sanda Mihaescu1, Magdoiu Anca Magdalena3, Gelu Onose1,2
Corresponding author: Aurelian Anghelescu, E-mail: aurelian_anghelescu@yahoo.co.uk

1. Teaching Emergency Hospital Bagdasar-Arseni, Bucharest

2. Carol Davila Medicine and Pharmacy University, Bucharest
3. CMI Dr Magdoiu Anca, Bucharest
Abstract.
Decompressive craniectomy (DC) is an emergency neurosurgical procedure used in cases of severe
intracranial hypertension, a condition commonly associated with severe TBI. The procedure is often life-
saving, but it exposes the brain to atmospheric pressure in the subsequent neurorehabilitation period, which
alters intracranial CSF physiology and leads to complications such as hydrocephalus, hygroma.
The indications for cranioplasty after decompressive craniectomy are for restoring brain protection and
aesthetic appearance. Studies have repeatedly noted improvement in neurological status after cranioplasty. It
restores normal intracranial physiology with respect to changes in intracranial and postural pressure. A
systematic review suggests that this intervention improves the hydrodynamic balance of the CSF disturbed
after decompressive craniectomy, with concomitant improvement in neurological function.
The case presents a male patient, monitored for 6 years (12 in-patient admissions and 4 out-patient
evaluations).
At age 59, the subject had suffered a severe head injury (02.07.2014, affirmative by accidental fall from 3 m)
with multiple hemorrhagic lesions (bifrontal, bioccipital, biparieto-temporal) and left cerebral subdural
hematoma. On 04.07.2014 a large fronto-temporo-parietal decompressive left craniotomy was performed, for
the mass lesion evacuation. Acute evolution was exacerbated by a severe toxic hepatic cytolysis (probably
induced by thienam)
He was addmited to the neurorehabiliation Clinic during 31/07/2014 - 24/10/2014. The neuropsychological
condition was severely degraded, had right hemiplegia and mixed aphasia, intense psycho-motor agitation,
severe dysphagia for solids and liquids, neurogenic bladder, anemia.
Cerebral CT examination revealed the persistence of a small residual parieto-occipital hematoma (resolved
gradually during hospitalization).
The patient had a favorable neurological evolution: he gradually recovered the receptive and then (partially)
the expressive component of the language.
The psycho-organic syndrome with psychomotor agitation and episodes of hetero-aggressiveness, reversal of
the sleep-wake rhythm and negativism were partially solved (even though present at discharge). The
swallowing and bladder continence were significantly improved. The hand functional gripping ability was
mostly recovered, the subject could walk, requiring permanent support and supervision for daily activities
related to nutrition, self-care, problem solving and interrelation. Barthel disability score was 35%
In the first decade of January 2015, cranioplasty was performed by fixing a composite material. After
cranioplasty, there was a rapid decline of the neurological status, worsening of the locomotor capacity, severe
ataxia (constant tendency to right latero-deviation, requiring bilateral support), worsening of speech and
swallowing (especially for fluids), increased neuropsychiatric agitation, negativism, incontinence, disruption
of the cognitive and executive superior cerebral functions (MMSE = 6/30, Barthel score = 5%).
The comparative analysis of the CT scans revealed an active internal hydrocephalus (the 3rd ventriculus
diameter had increased from 10-11 mm to 18 mm), cerebral interstitial edema, and associated ischemic
vascular injury. The CT scan imaging was paralled by the atrophic changes of the optic nerve papilla. The
manometric evaluation detected increased pressure values (200 mm), indicating a decompressive shunt.
L40
The family prefered the primary conservative approach. The synergistic combination of inhibitors of CSF
secretion (acetazolamide 750 mg/ day), dexamethasone, neurotrophic factors, anticonvulsants (CBZ 600 mg/
day), sedatives and neuroleptics were followed by a slow improvement, gradualy achieved in 7 months, time
required for re-balancing the intracranial pressure.
In November 2015 he still had important dysmnesic elements (MMSE was 18/30), but no longer urinaly
incontinence. The vertical balance was improved, and the Barthel score was 45%.
Around the winter Holidays 2015 seizures had appeared (focal epilepsy with secondary generalization), which
imposed modification of the therapeutic regimen (levetiracetam 1000 mg and trileptal 300 mg).
The kinetic programs were gradually adapted to the progressive neurological evolution.
From January 2016 no seizures has occurred. The family has reported two short episodes of TS disorientation
and dizziness, interpreted as a complex psycho-cognitive focal symptomatic epilepsy (juged in the context of
the bioelectrical modifications).
On the last 3 EEGs (2016-2019) a focal pathological electrical pattern has persisted. In November 2019 his
last Barthel score was 55%, the paretic limbs deficit was almost non-existent, and the patient had a good
psichological recovery (film).
Conclusions
Despite the poor biological condition and severe brain injuries (post-traumatic and post-surgical) the subacute
neurological evolution was favorable during the subject`s first admission to the Neurorehabilitation Clinic.
Due to the precarious clinical condition, cranioplasty after decompressive craniectomy was not performed
earlier (below 85-90 days), which explains the major differences between pre- and post-cranioplasty
neurological status, neuro-psychic "collapse" and rapid CT image degradation.
Extended craniectomy, Barthel≤70 and age over 45 years are independent predictors of complications, aspects
highlighted in the literature and cumulated in the presented case.
The global neurological evolution was gradually favorable (towards a mild, almost imperceptible ataxic
hemiparesis, in Nov. 2019), in parallel with the stabilization of the intracranial pression. This statement is
supported by the cerebral CT imagery: from an active internal hydrocephalus, with signs of evolutivity and
interstitial edema, associating ischemic lesion, towards a normotensive asymmetric hydrocephalus and
porencephaly (although gigantic and deforming), but stable and stationary during the last 4-5 years of
evolution.
The contrast between the impressive imagery aspect and the incredibly good neuropsychological status was
the reason for presenting the case as a neurorehabilitation "saga", with an evolution spread over six years.
The paper advocates for a carefully follow-up and prompt intervention in order to prevent recurrences and /
or complications (secondary and tertiary prophylaxis).
Key words: subdural hematoma, decompressive craniectomy; cranioplasty; hydrocephalus; post-traumatic

encephalopathy; neurorehabilitation
L40
L41 - Management of tenosynovitis (de Quervain’s disease) of the wrist
Doina Maria MOLDOVAN¹, Gabriela DOGARU²
Corresponding author: Doina Maria MOLDOVAN, E-mail: ortoped687@gmail.com
1. Orthopedic and Traumatology Clinic Division, Targu Mures

2. “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Clinical Rehabilitation Hospital Cluj-Napoca
Abstract
Introduction. De Quervain’s tenosynovitis is defined as the inflammation of the synovial sheath of the
tendons in the first extensor compartment of the wrist (abductor pollicis longus APL and extensor pollicis
brevis EPB tendons).
Material and method. Using PubMed, Medscape and Cochrane databases, 12 articles dealing with this
specific issue were found. The articles were published in English during the period 2015-2020. A good
management of tenosynovitis allows establishing the steps and the method (conservative or surgical) to be
followed in the case of patients with de Quervain’s tenosynovitis (dQ).
Results. Tenosynovitis treatment includes many methods, most of which are conservative. The treatment
method with the highest success rate is corticosteroid injection (CSI) at four separate sites in the first dorsal
compartment of the wrist and prescription of orthoses. In some patients with a high relapse rate of dQ
tenosynovitis, the presence of a fibrous septum subdividing the first extensor compartment has been
reported. Corticosteroid injection does not have the expected effect in these patients. Ultrasound is the
easiest method that can detect the presence of the fibrous septum. The recommended treatment for these
patients remains surgical treatment.
Conclusions. The choice of conservative or surgical treatment for patients with dQ tenosynovitis depends on
the absence or presence of an accessory fibrous septum subdividing the first extensor compartment.
L41
L42 - The Management of secondary hip osteoarthritis after essential epiphisoilisis using
viscosupplementation.
S. Demirgian, V. Marin, T.V. Surdu, M. Surdu, O. Surdu
Abstract
Introduction: Slipped femoral capital epiphysis(SPCE) occurs during the adolescent rapid growth period
when the epiphyseal growth plate is weakened and the capital epiphysis is displaced downward and backward.
The immediate effect is a disabling external rotation deformity of the lower extremity. The early serious
sequelae are avascular necrosis of the femoral head and chondrolysis which involves the opposing acetabular
and femoral articular cartilage and eventuates in an intractable painfull, stiff hip.
Material and method: We present the case of 35 years old man, diagnosed with essential epiphyseolisis. The
simptomatology had an insidious onset with walking difficulties (gait abnormalities) and hip pain for few
month. The patient was evaluated anamnestic (history of the illness), clinical and paraclinical .
Results: Taking into account the age of our patient we decided to treat conservatory, meaning medication,
complex physical treatment and viscosupplementation.
Conclusion: SPCE was first described in 1889. The disease is not common for the age of our patient, the
period of rapid growth from 10-17 years of age. The patient was during his childhood under treatment with
anterior pituitary growth hormone, and can explain the late debut of disease. Viscosupplementation was tried
in order to try to avoid for know the hip arthroplasty.
Keywords: Slipped femoral capital epiphysis, anterior pituitary growth hormone, painfull, stiff hip.
321
L43 - God`s Mathematics: 1+1 Equals More than we Know. Favorable Evolution from
Vegetative State and Severely Deposturizing Tetraplegia, To a Minimum State of
Consciousness, Then Post-Traumatic Encephalopathy and Functional Tetraparesis
Aurelian ANGHELESCU1,2, Catalina AXENTE1, Cristi RADUCAN1, Anca Magdalema MAGDOIU3,
Gelu ONOSE1,2
Corresponding author: Aurelian Anghelescu, E-mail: aurelian anghelescu@yahoo.co.uk
1. Teaching Emergency Hospital “Bagdasar-Arseni”

2. University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
3. CMI Dr Anca Magdoiu
Abstract
Introduction. Survivors of severe brain trauma (TBI) have marked disorders in the state of consciousness,
from coma to vegetative state (VS) and minimal state of consciousness (SMC).
The VS is described as a pathological condition characterized by complete absence of any conscious activity
(no self-awareness, no connection to the environment), with complete or partial preservation of the
hypothalamus, and autonomic brain stem functions. Only 14.29% of patients in VS manage to recover; good
outcomes factors being young age, male gender, cause of brain injury, time elapsed from TBI at the
beginning of the neurorehabilitation program.
Case presentation. A 21-year-old female patient, student, was transferred to Bagdasar Arseni Hospital
neuromotor rehabilitation clinic on 08.10.2019 in vegetative state (alert state without consciousness, psycho-
sensory a-reactivity), severe spastic tetraparesis with amyotrophy and myo-tendon retractions, with disabling
deformations and quasi-irretrievable flexed upper limbs, severe malnutrition, feeding through gastro-stoma,
neurogenic bladder, SUF. Medical history: on 20.08.2019 the patient suffered a polytrauma after falling
from heights (defenestration from 30 meters, the 8th floor of the building - possible suicide attempt),
followed by severe TBI (GCS 6p at hospitalization), with multiple cerebral hemorrhagic foci (operated), C7
spinal fracture (conservatively treated), chest trauma and pulmonary concussions. After the resolution of the
brain hemorrhagic foci, the patient was monitored almost two months in the ICU. Tracheotomy with
cannulation, and gastro-stoma feeding by PEG were necessary. The global evolution has been shaped to a
vegetative state. Muscle spasticity and deformities were corrected by local spasmolytic therapy with
botulinum neurotoxin, injected at our clinic (but rather late, in the evolutionary stage) combined with a
sustained program of kinetotherapy and electro-physiotherapy (posture correction, use of assistive devices
and orthoses), mobilization, progressive verticalization, laser program and diapuls). Medication consisted of
prophylactic anticoagulant treatment, gastro protection, antibiotic episodes of infections, synergistic
association of neurotropic factors, anticonvulsants. The patient gradually began to vocalize, her face became
more expressive, she voluntarily mobilized her limbs; she has improved from vegetative state to a state of
minimal consciousness, then to post-traumatic encephalopathy with functional spastic tetraparesis.
At discharge she was able to walk with bilateral support on the parallel bars, assisted by the physiotherapist.
Her cognitive and executive cerebral functions showed remarkable evolution.
Conclusions. Approach to patients in VS is realized in an inter- / multidisciplinary team, having in epicenter
rigorous measures of neurorehabilitative nursing, to overcome complications and improve the patient's
biological status. Along with the complex recovery program, the family had a major supportive role, along
with the spiritual, religious assistance. Ad vitam prognosis of ad functinem outcomes depends on a long-
term rehabilitative treatment, and sustained psychological support. It also involves socio-economic and
legislative factors. The main objective, the “final piece of the puzzle” is represented by the socio-vocational
reintegration (return as a student).
Keywords: TBI, vegetative state, tetraplegia, minimally conscious state, post-traumatic encephalopathy,
botulinum neurotoxin
L43
L44 - Very Complex, Difficult and Sustain Rehabilitative care Management in a case of
Vegetative State secondary to Anoxic Encephalopathy after Acute Myocardial Infarction, with
Connected Comorbidities such as Pressure Sores and Deep Venous Thrombosis in a lower limb
Luminița NIRLU1, Ana Carmen REBEDEA1, Laura Georgiana POPESCU1,
Ali OSMAN SAGLAM1, Gelu ONOSE 1,2
Corresponding author: Luminița NIRLU, E-mail: nirluluminita@gmail.com

Abstract
Introduction. Hypoxic-ischemic brain injury encompasses a complex constellation of pathophysiological
and cellular brain injury induced by hypoxia, ischemia, cytotoxicity, or combinations of these mechanisms.
HIBI after cardiac arrest is a leading cause of mortality and long-term neurologic disability, including
significant changes in personality and cognitive impairments in memory, cognition, and attention, in
survivors (1) (2).
Materials and Methods. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-
Arseni” Ethics Committee N.O 34132 from 18.11.2019, the current case report presents a 62-year-old male
patient diagnosed with vegetative state after hypoxic-ischemic encephalopathy secondary to resuscitated
cardiac arest, pharmacologically active stent angioplasty, tracheostomy, stage 3 hypertension, gastrostoma
feeding, neurogenic bladder (indwelling catheter), myoclonic status epilepsy at onset, chronic obstructive
lower limb arteriopathy, single surgical kidney. The patient was admitted in the Neurorehabilitation Clinic of
the Teaching Emergency Hospital „Bagdasar-Arseni” (TEHBA) Bucharest, Romania, associating severe
alteration in self-care abilities, locomotor dysfunction and specialized rehabilitation treatment and nursing.
Results. The clinical and functional evaluations were objectified through the assessment scales/scores
implemented in our Clinic’s Division. The patient had a stationary evolution during his 71 days of
hospitalization, the scale scores remains the same at the admission and at the discharge: Motor FIM
(Functional Independence Measure) 13/91, Cognitive FIM from 5/35, Asworth modified scale 1, Penn scale
1, GOS-E scale 2/8, Rankin scale 5/5, Stratify Risk Scale 0/6, FAC (Functional Ambulation Categories) 0/5.
Conclusions. Our main objective was, first of all, to avoid any new complications, to which this disease is
mostly prone. This has been an ample and complex challenge for our entire neurorehabilitation team due to
multiple comorbidities (stage 3 hypertension, ischemic heart disease, sores, deep venous thrombosis,
multiple urinary tract infections). The approach of such a clinical case involved keeping the patient in an
overall stabilized state, regarding his basic biology and somatic functions. His progresses were small but
quite important and the neurorehabilitation team was constantly adapting the therapeutic plan to the
extremely numerous restrains. The prognostic of this patient remains, however, reserved.
References
1.[https://www.researchgate.net/publication/236912972_Prolonged_Delirium_Secondary_to_Hypoxic-
ischemic_Encephalopathy_Following_Cardiac_Arrest. [Online]
2.https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1670-9. [Online]
L44
L45 - Very Good Neuromotor and Psycho-Cognitive Rehabilitation Outcomes in a Post-TBI Patient
with Initially Severe Fidget and Breath Insufficiency, with Secondary Eso-Tracheal Fistula, after
Necessity Tracheostoma in Subsequent Important Pulmonary Complications - Case Report
Laura Georgiana POPESCU1, Luminița NIRLU1, Ana Carmen REBEDEA1, Ali Osman SAGLAM1, Gelu ONOSE1,2
Corresponding author: Laura Georgiana POPESCU, E-mail: laurapopescy@yahoo.com
1 Teaching Emergency Hospital „Bagdasar-Arseni” Bucharest (TEHBA)

2 University of Medicine and Pharmacy “Carol Davila” in Bucharest, Romania
Abstract
Objective. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics
Committee’s approval, N.O. 34137/18.11.2019, this article presents the evolution of a 59-year-old patient
involved in a road accident (pedestrian) with severe TBI, severe fidget and breath insufficiency with secondary
eso-tracheal fistula, after necessity tracheostoma in subsequent important pulmonary complications.
Results and methods. The data presented include patient history, clinical and imaging examinations,
assessments of neuro functional deficits through specific scales, medical and kinesiological treatment that led
to favorable patient progression from psycho-cognitive status after severe TBI (severe psychomotor agitation
and dislogia, bifrontal syndrome, post-traumatic encephalopathy) in polytraumatic context associated with
locomotor and self-care dysfunction, neurogenic bladder and complicated with eso-tracheal fistula after
necessity tracheostoma due to subsequent important pulmonary complications to slight tetraparesis with
predominance of motor deficiency in the lower limbs (left rather than right), remitted high tracheal stenosis
secondary to the operated eso-tracheal fistula, remitted neurogenic bladder, with the patient verticalization,
maintaining orthostatism and mobilization over small distances.
Discussions/Conclusions. The particularity of the case: the favorable progression which emerged after a
persistent therapeutic rehabilitation team-run program despite the limitations imposed by the mental state of
the patient during hospitalization and the presence of multiple severe pulmonary complications that required
treatment performed in collaboration with other specialists.
Keywords: neuromuscular rehabilitation, traumatic brain injury, bifrontal syndrome, polytraumatism, eso-
tracheal fistula.
L45
L46 - THE ROLE OF FIBROBLASTS AND TGFβ IN THE PATHOGENESIS OF SYSTEMIC
SCLEROSIS
Mihaiela CHICU, C.C. COPACIANU
University of Medicine and Pharmacy U.M.F. “Gr.T. Popa” Iasi

Clinical Emergency County Hospital “Sf. Spiridon” Iasi
Abstract.
Introduction
Fibrosis is the marker of the disease, being the consequence of the interaction between vascular dysfunction
and immune abnormalities in individuals with genetic predisposition.
The excessive deposit of matrix components increases the stiffness and irreversible tissue remodeling.
Discussion
The fibroblasts activation in scleroderma is a consequence of the cells interactions, reactive oxygen species,
cytokines, mechanical stimulation. The pathological fiubroblasts has uncontrolled activity, resulting an excess
acumulation of extracellular matrix components.
Fibrosis gene expression is related to autocrine, endocrine and paracrine factors, cell interactions, hypoxia,
reactive oxygen species. Many cytokines are involved; between them, the TGFβ has the most important
role. The three isoforms of TGFβ are secreted by platelets, novocites / macrophages, dendritic cells,
fibroblasts.
TGFβ is primarily responsible for:
- stimulating the synthesis of collagen, fibronectin, proteoglycans, elastin;
- stimulating the release of endothelin-1 (ET-1);
- the generation of oxygen free radicals;
- inhibition of apoptosis of fibroblasts and myofibroblasts.
Conclusions
The changed Rodnan score is the gold standard for evaluation of skin fibrosis in patients with
scleroderma. Although fast and noninvasive, the Rodnan score has some limitations because it is subjective,
varying between various evaluators, it is a semi-quantitative assessment and can not differentiate between
edema, thickening, adhesion.
However, at this time it is the only valid measuring instrument of skin fibrosis.
Keywords: fibrosis, fibroblast, TGFβ.
L46
L47 - The gripping recovery in rheumatoid arthritis patient by combining kinetotherapy
with TuiNa massage
Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Oleg PASCAL1, Mihail CÎRÎM1

1.The University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau, Republic of Moldova

The Department of Medical Rehabilitation, Physical Medicine and Manual Therapy
Abstract
Introduction. Rheumatoid arthritis (RA) is a chronic inflammatory joint disease with autoimmune
pathogenesis and unspecified etiology. [1, 3, 6] It is characterized by symmetrical arthropathy with rapidly
deforming and intensely destructive evolution. The clinical picture of the disease is inflammatory joint pain.
Pain specific is the increased rest and pain reduction during joint mobilization. Functional treatment involves
limiting the installation of joint deformities, maintains muscle tone and joint mobility, and maintains a
psychological and social balance of the patient. [2, 4]
Case presentation. The AC patient with the diagnosis of rheumatoid arthritis, the activity level DAS /
DAS28 2.85, the age of 64, the urban environment, former professional sports basketball, was admitted to
the IMSP "State Hospital" (Chisinau) accusing physical asthenia, fever nocturnal, inadequacy, weight loss,
myalgia, symmetrical joint pain in the joints of the hand, morning joint pain for 90 minutes. By testing pre-
tension (Sidenco, 2005; Frost, 2002) [5] the following parameters were determined: when testing two-finger
pens and police-fingers: 7 points, testing of poly-finger pens 2 points, testing palms 5 points. The pain was
evaluated according to the VAS scale with 8-9 points. For the evaluation of the quality of life, the HAQ
(Health Assessment Questionnaire) scale was applied, initially the score being 2.08 points.
The patient is non-smoker and denies alcohol and drug use, the disease is 19 years old
Results. The patient received drug treatment and conventional rehabilitation therapy (kinetotherapy,
electrotherapy) and TuiNa massage for 8 weeks. At the end of the treatment the morning redness decreased
to 30 minutes, the test of the two-fingered pens and the police-fingers accumulated 3 points, the testing of
poly-finger pens 0 points, testing handheld pens 2 points. The pain evaluated according to the VAS scale
was 4-5 points and the daily activities after the HAQ scale 0.9 points.
Conclusions. The complex programs of medical rehabilitation with kinetic techniques associated with the
assisted and individualized TuiNa massage have considerably improved the functional status of the person
with functional retention of the rheumatoid hand.
The two-finger and police-finger tweezers test, the poly-finger tweezers test and the hand-held tweezers test
can be gripping assessment tools for the rheumatoid hand.
Key words: Rheumatoid arthritis, pre-tension evaluation, TuiNa massage
References
1.Brăilescu Consuela, Methods for clinical and functional evaluation of the post-traumatic and/or post-surgical hand, Palestrica Mileniului III ‒
Civilizaţie şi Sport Vol. 12, no. 2, Aprilie-Iunie 2011, p.151‒158
2.Chihai V. Principii de reabilitarea funcțională în artrita reumatoidă. În Buletinul Academiei de Științe a Moldovei Științe medicale, 2 (54),
2017, p. 324-326
3.Onose G. Recuperare, Medicină Fizică şi Balneoclimatologie - Noţiuni de bază şi actualităţi. Vol.1, Ed. Medicală, Bucuresti 2008, p.90-117
4.Opriș-Belinschi D. și a. Durerea în patologia reumatică. În Terapia durerii, București , 2017, p.101
Ruddy S. et all.Epidemiology of the rheumatic diseases in Kelley's Textbook of Reumatology ,1st volume, 2008, p.321-333
5.Sidenco EL. Metodica recuperării mâinii-Aplicaţii în kinetoterapie şi medicina sportivă. Ed. Fundaţiei România de Mâine, Bucureşti 2005,
p.100-152
6.Zhang B., Combe B., Rincheval N., Felson DT. Validation of AC/EULAR dcefinition of remission in rheumatoid artritis from RA practice:the
ESPOIR cohort . Arthritis Res Ther. 2012, jun 29; 14(3):R156
L47
L48 - Upper Back Pain, Neck Pain and Stress in school children
Monica Adriana FARAGO1, Manuela Simona POP1

Corresponding author: M.A. Farago, E-mail: monica_farago@yahoo.co.uk
1. University of Oradea, Faculty of Medicine and Farmacy, Romania
Abstract
Introduction. Stress can affect anyone who feels overwhelmed – even kids, and in consequence, they are
exposed to an increased risk of multisystem health problems, often with poor health outcome in adulthood.
Aim of the study. to demonstrate if somatic pain in children (upper back pain in this study) is correlated to
their stress, poor posture activities, or due to both conditions.
Material and method. The subjects (n=31) were hospital outpatients, with ages between 7 to 16 years old,
referred to rehabilitation department for upper back pain ± dysfunction. Pain was measured by Children Pain
Rating Scale. The clinical exam appreciated: weight issues, postural control, muscle pain and contraction and
joint range of motion. The interview included questions regarding the number of hours spent in seated
positions per day, daily time screen, sport activities and daily stress sources.
Results. A mild to moderate level of pain; most of the children had problems in postural control (forward head
posture, kyphosis, rounded shoulders, hyperlordosis); contracture in upper trapezius, levator scapulae,
pectoralis, quadratuslumborum and hamsting muscles; seated position time ≥ 9 hours/day; screen time 1-4
hours/day; no sport activities; stressors identified in all patients; poor sleep in 50% of the patients. Upper back
pain was correlated to prolonged seated positions with arms in front of the body, but also to the stress and
anxiety that is recognized in the subjects.
Conclusions. If we recognize the stress in the etiology of upper back pain in children, in addition to
rehabilitation therapy, for optimal therapeutic results, we should take psychological interventions into account
too.
Key words: upper back pain, stress, schoolchildren.
L48
L49 - PSYCHOLOGICAL DIMENSIONS OF POST-STROKE REHABILITATION
Aurelia Glavan
Email: glavan_aurelia@yahoo.com
Emergency Medicine Institute, Chișinău, Republic of Moldova
Abstract.
Introduction: The traditional forms of psychological assistance in medical institutions are limited due to the
shortage of qualified psychologists, thus greatly influencing the effectiveness of rehabilitation. The
psychological service takes into account: organization of psychoeducational programs, development of the
mentained person-environment resources, learning the self-managing behaviour for the adjustment to the
disease. We set out an experimental research of the psychological state of individuals during the post-stroke
rehabilitation, which takes them, as well as their families, through physical and emotional pain, carried out
during 2017-2019, in the neurology wards of the Emergency Medicine Institute, Chișinău.
Phase I
Sample - 110 people in post-stroke rehabilitation with emotional changes versus 50 persons without.
Objective: review of the particularities of the affectivity of adults aged 18-75 after stroke ;
Materials/Methods: Mental state assessment Test by H. J Eysenck.
The values of anxiety, frustration, aggression, rigidity were highlighted, because of higher indices,
serving as elements that block the rehabilitation.
N Mental states Group 1 Group 2 p

M±m M±m
1. Anxiety 11,76±0,39 11,48±0,53 p>0,05
2. Frustration 10,77±0,43 10,26±0,66 p>0,05
3. Aggression 10,94±0,44 11,36±0,58 p>0,05
4. Rigidity 11,41±0,37 12,36±0,48 p>0,05
Phase II
Psychotherapeutic intervention program: Self-regulation of the affective-behavioral range of people
during the post-stroke rehabilitation period
Goal - forming the skills for emotional-behavioral self-regulation in post-stroke individuals.
Objective: decrease of psycho-emotional tension; installing the state of relaxation; balancing mental states;
stimulation of positive self-perception.
Sample — 20 subjects with increased indices (10 subjects in the control group; 10 subjects in the training
group); the presence of disability after stroke. Ten sessions were held with each subject, lasting 60 minutes
each.
Evaluation of the intervention program’s efficiency: two groups of ten subjects each were researched -
experimental retest group, control group; a direct comparison was made between the studied groups.
Conclusions
The evaluation identified negative affective states: anxiety, aggression, frustration, in response to
long-term rehabilitation overloads.
The Eysenck test showed the modification of all its indices, following the Psychotherapeutic
Intervention Program, demonstrating an adaptable behavior to social factors.
L49
L50 - ESSENTIAL OILS USED IN SPA CENTERS IN THE EUROPEAN UNION: LEGISLATION
ASPECTS AND POTENTIAL BENEFICIAL EFFECTS
Andreia Corciovă1, Ana Flavia Burlec1, Alina Săcărescu2, Irina Macovei1, CorneliaMircea1,
Monica Hăncianu1
1
2
“Grigore T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iași, Romania
Abstract.
Essential oils, also known as volatile oils, have a series of uses in the food and cosmetic industries, being
extensively used in aromatherapy as well. Among the most popular ones are those obtained from lavender
(Lavandula angustifolia), bergamot (Citrus aurantium var. bergamia), eucalyptus (Eucalyptus globulus),
frankincense (Boswellia caterii), tea tree (Malaleuca alternifolia) and peppermint (Mentha piperita var.
vulgaris)1. Depending on the content, form of presentation and intended use, essential oils are subjected to
various European requirements. The main guideline regarding essential oils used in cosmetics for the
European Union is the Regulation (EC) No 1223/2009 of The European Parliament and of The Council of
30 November 2009 on cosmetic products, which aims to ensure their high quality in order to protect the
health and safety of consumers2.
It is generally known that volatile oils present important antibacterial, antifungal and antiviral properties,
given their high content in terpenoids. Other indication areas have been included, such as digestive, immune,
nervous, vascular and respiratory systems3. Nevertheless, some essential oils possess an important
sensitizing potential, therefore their correct use is vital4.
Essential oils can be administered through different routes such as inhalation or dermal application through
massages. These two forms of administration used in the treatment of stress, anxiety or as to improve
concentration and well-being represent the fundamentals of aromatherapy. The available scientific literature,
as well as the traditional use of essential oils have suggested them to be helpful in diseases such as
Alzheimer’s, cancer and sleep disorders5. Through multiple and complex mechanisms involving the sense of
smell, essential oils have a great impact on the limbic system and the entire brain. The role of such
compounds is just beginning to be understood, but evidence so far suggests they could play an important part
as complementary treatment in several neurological diseases6.
References
1. https://www.cbi.eu/market-information/natural-ingredients-cosmetics/essential-oils-aromatherapy/.
2. Barbieri C, Borsotto P. Essential Oils: Market and Legislation. In: Potential of Essential Oils.
InTech; 2018.
3. https://www.cbi.eu/sites/default/files/market_information/researches/product-factsheet-europe-
aromatherapy.pdf.
4. https://www.edqm.eu/en/guidance-essential-oils-cosmetic-products.
5. Ali B, Al-Wabel NA, Shams S, Ahamad A, Khan SA, Anwar F. Essential oils used in aromatherapy:
A systemic review. Asian Pac J Trop Biomed. 2015;5(8):601-611.
6. Wang Z-J, Heinbockel T. Essential oils and their constituents targeting the GABAergic system and
sodium channels as treatment of neurological diseases. Molecules. 2018; 23(5):1061.
L50
L51 - MEASURING COMORBIDITIES IN STROKE REHABILITATION – IS INTERNATIONAL
CLASIFICATION OF DISEASE ICD-10 A USEFUL TOOL?
A.Melnic1,2, A. Staver1, O. Pascal1,2
1- “Nicolae Testemitanu” State University of Medicine and Pharmacy, Department of Medical Rehabilitation,
Physical Medicine and Manual Therapy, Chisinau, Republic of Moldova
2- Institute of Neurology and Neurosurgery “Diomid Gherman”, Chisinau, Republic of Moldova
Abstract.
Introduction. During post-stroke rehabilitation, medical specialists can report a wide range of comorbidities.
Many healthcare providers use International Classification of Disease 10 (ICD 10) in order to monitor the
occurrence of multiple conditions. Even though ICD 10 remains a common tool of monitoring the
comorbidities, its application for post stroke rehabilitation remains unclear.
Purpose of the study. To determine whether the ICD 10 model is adequate for assessing comorbidity patterns
of post stroke persons enrolled in rehabilitation.
Material and methods. Comorbidity profiles of 252 persons with stroke admitted to Neurological
Rehabilitation department and frequencies of events according to recorded ICD-10 system was assessed.
Results: 81 different codes recorded according to ICD -10 (among them 32 codes single entries), were
attributed to risk factors, complication and concomitant disease as groups of comorbidities. Diseases of the
circulatory system (I00-I99) was in the top of comorbidities profiles counting 601 entries as follows:
hypertensive heart failure - 154 cases, atrial fibrillation - 67 cases, carotid arteries occlusion 56 cases and
others. Among the codes, representing risk factors, and concomitant disease were endocrine/ nutritional and
metabolic diseases (E00-99) represented by diabetes – 77 cases, obesity - 37 cases. Functional deficits
presented mainly by codes of hemiplegia (G81) - 140 cases and speech disorders (R47) in 119 cases. Mental/
behavior disorders (F00-99) or musculoskeletal diseases (M00-99) were another important groups of
comorbidities that belong to complications. At the same time, it was difficult to present ICD-10 codes to a
specific group of comorbidities. Combination of ICD-10 with functional classifications and comorbidity
indexes can provide more clearness.
Conclusions: ICD-10 system offers important information upon comorbidities encountered within
rehabilitation post stroke but its use remains challenging / with gaps in monitoring comorbidities.
Keywords: stroke rehabilitation, comorbidities, ICD-10
L51
L52 - The Importance of Neuromotor Stimulation in Term Born Infants
Monica Adriana FARAGO1, Manuela Simona POP1
Corresponding author: Manuela Simona POP, E-mail: drpsimona@gmail.com
1. University of Oradea, Faculty of Medicine and Farmacy, Romania
Abstract
Introduction. Infancy is a time of intense development. In the presence of touch and affection from their
caregivers, they grow and thrive properly.
Aim of the study: to identify movement and motor skills delay in term infants and the proper rehabilitation
interventions they need.
Materials and Methods. The subjects (n=28) were healthy outpatient infants born at term, between 6 and 12
months old, referred to the rehabilitation department for motor delay. They were evaluated for attention,
emotional and motor skills in relation to the indicative scales of normal infants grow. Mothers interview
included questions about the duration and structure of time spent with the infant and the level of stress and
anxiety related to this task. Physiotherapeutic interventions: 10 sessions infant massage and exercises for
postural control, movements coordination, mother’s education.
Results. In the presence of normal growth, all subjects showed short eye contact, all motor skills reported to
their age were delayed, low resistance to the first rehabilitation session which were correlated to mothers fear,
anxiety and lack of information concerning the importance of motor and sensitive infants stimulation. Through
mother’s education and 10 sessions of physiotherapy (infant massage and exercise), infant attention, back
control and resistance to exercise improved. Some of the mothers reported better sleep and mood in infants.
Conclusions. 1. In order to promote the bonding between baby and parent, the motor, sensitive and cognitive
skills in infant, the basis for the development of a future balanced and healthy adult, early physiotherapy
evaluation and interventions are needed.
2. Social and medical systems to support more efficient infants educational and physiotherapy interventions
are needed.
Key words: motor delay, neuromotor stimulation, physiotherapy.
L52
L53 - Impact of Mood and Cognition Disorders in Post Stroke Rehabilitation
A. Melnic1,2, O. Pascal1,2, S. Pleșca1,2
Corresponding author A. Melnic, E-mail: adrian.melnic@usmf.md
1. “Nicolae Testemitanu” State University of Medicine and Pharmacy, Department of Medical rehabilitation,
physical medicine and manual therapy, Chisinau, Republic of Moldova
2. Institute of Neurology and Neurosurgery “Diomid Gherman”, Chisinau, Republic of Moldova
Abstract
Introduction. Cognitive and mood disorders after stroke are common comorbidities being associated with
poor rehabilitation outcomes. At the same time, these conditions can overlap and cause low level of
functioning in stroke patients.
The purpose of the study was to evaluate the incidence and distinctive profile of cognitive and mood
disorders and its impact on rehabilitation outcomes.
Material and methods. Individuals (N=60) with stroke admitted in the department of Neurological
Rehabilitation of the Institute of Neurology and Neurosurgery, Chisinau, Republic of Moldova were
evaluated using Montreal Cognitive Assessment Scale (MoCA), The Hospital Anxiety and Depression Scale
(HADS), and Barthel Index at admission and discharge.
Results. Cognitive dysfunction in post stroke rehab have been registered in 87 % (mild -27%, moderate -38
%, severe forms – 22 % ) with average MoCA score of 17.18 points (SD± 7,4 ). The most affected area of
cognitive function was visuospatial perception, memory and attention. Functional outcomes measured by
difference of Barthel Index at admission and discharge are higher in persons with higher cognitive score
(Pearson’s r =+0.65). Anxiety and depression were present in 30 % and 35 % of study group having a mean
score of 9.6 for anxiety (SD± 5,6) and 8.9 for depression (SD± 3,56) . A negative correlation between
depression score vs anxiety score and functional outcomes were registered with a stronger statistical
significance for depression (Pearson’s r=-0.59 versus -0.31)
Conclusions. Cognitive intervention for training of visual perception, attention and memory can improve
functional outcomes for post stroke rehabilitation. Cognitive and mood disorder occur frequently as
comorbidities in stroke and have to be considered by the multidisciplinary team.
Key words: cognitive disorders, anxiety, depression, post-stroke rehabilitation
L53
L54 - The Effects of Cupping Therapy in the Treatment of Lumbar Algal Syndrome
Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Svetlana PLEȘCA1, Maxim LUPU1
1. State University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau, Republic of Moldova, The
Department of Medical Rehabilitation, Physical Medicine and Manual Therapy
Abstract
Introduction. Lumbar algal syndrome is defined as pain that persists over 12 weeks and is determined by
degenerative or traumatic vertebral processes. Chronic back pain is the costliest benign health problem faced
by patients in industrialized countries and one of the most common causes of limiting the activity of persons
under 45 years of age. [2,4] The treatment of chronic back pain can be structured. In 3 phases depending on
the duration of symptoms. From the first stage of the disease, physiotherapy with analgesic effect,
myorelaxant, and anti-dementia is recommended, in combination or not with the drug treatment. [3,5] These
treatment schemes may also be followed in the following stages of pathology.
Case presentation. Patient B.C. male, 44 years old, originally from the rural area, as a driver was admitted to
the IMSP "State Hospital" (Chisinau), with accusations of pronounced lumbar pain, stinging and irradiation
in the lower limb straight up to the knee level with acute exacerbation during the meal and prolonged
orthostastatism. From anamnestic: The patient is a smoker for 20 years, leads a sedentary lifestyle, lumbar
pain for 6 years with exacerbations 2-3 times a year. Established diagnosis: Subacute Lombosciatica on the
right of vertebrogenic origin, persistent moderate algal syndrome; static and walking disorders; obesity grade
I. The value of the algal syndrome tested according to the VAS scale was evaluated by the patient with 9-10
points. Signs of elongation: The Lasegue and Wassermann-Matskevich tests were positively appreciated on
the right. Functional testing according to the Oswestry Disability Index Questionnaire [1] was scored by 4
points, finger-soil test = -23cm, Șober test = 10/12 cm. Quality of life was assessed by 56 points after the
Short-Form Questionnaire [1].
Results. The patient received drug treatment and conventional rehabilitation therapy (kinetotherapy,
electrotherapy) in combination with dry cupping therapy along the path of the lumbar paravertebral
musculature. After 6 weeks from the beginning of the treatment the pain was noted with 2-3 points. The value
of the Oswestry Disability Index Questionnaire reached 1 point. Lasegue and Wassermann- Matskevich tests
- negative bilateral, finger-sol test = -4cm, Șober test = 10/15 cm. The summary value of the quality of life
indices increased to 89 points (Short-Form questionnaire).
Conclusions. The complex medical rehabilitation program associated with cupping therapy has greatly
improved the functional status and quality of life of the person with lumbar algal syndrome. Cupping therapy
can be a part of complex physio-functional rehabilitation programs.
Key words: lumbar algal syndrome, quality of life, cupping therapy
References
1.Durerea Lombară la adult. http://crdm.md/images/ups/protocol/pdf.2013
2.http://www.cnaa.md/files/theses/2019/55228/florentina cristea thesis.pdf
5.http://89.32.227.76/ files/14507-PCN-Durerea%2520lombar%25C4%2583.pdf
L54
L55 - Using Robot-Assisted Therapy in Children’ Pathology
Liliana PĂDURE1,2, Corina SPOREA2, Andrada MIREA1,2
Corresponding author: Corina SPOREA, E-mail: corina.sporea@gmail.com
1. University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
2. National Teaching Centre for Children Neurorehabilitation "Dr. Nicolae Robanescu",Bucharest, Romania
Abstract
Introduction. Modern therapy devices – Gloreha, Pablo, Myro, Armeo, Armotion, Diego – are nowadays
used to assess and train paralyzed upper limb.
Materials and Methods. We studied the evolution of more than 150 patients admitted to our hospital, which
received, besides the conventional physical therapy, the indication of robot-assisted therapy using upper limb
rehabilitation devices Gloreha, Pablo, Myro, Armeo, Armotion and Diego, which combines robotic
rehabilitation therapy with virtual reality facilities.
Results. Robot-assisted therapy enchants the child by interacting with image and sounds and coopting him
into a beneficial activity with faster and better results on his health condition.
Conclusions. Computerized assessment and therapy facilitate rehabilitation of all types of paralysis of the
upper limbs, both spastic and flaccid. State-of-the-art robot-assisted devices' facilities combined with virtual
reality elements has proven to have enhanced results in motor and cognitive children rehabilitation.
Key words: pediatric rehabilitation, children rehabilitation, upper limb rehabilitation, hand rehabilitation,
robot-assisted therapy
L55
L56 - Rehabilitation Challenges in a Patient with Stroke and Advanced Coxarthrosis
Dănuţ PĂCURAR1,2, Mihaela Ramona PĂCURAR1,2
Corresponding author: Dănuţ PĂCURAR, E-mail: icu_dan@yahoo.com
1. University of Oradea, Faculty of Medicine and Pharmacy,Oradea, Romania
2. Carei County Hospital
Abstract
Introduction. Stroke and degenerative osteoarthritis are frequently associated in adults at a certain age. Both
conditions are debilitating and reduce considerably the patient life expectancy. The diagnosis of degenerative
osteoarthritis is based on clinical findings and X-ray characteristics. According to World Heart Organization
there are no significant differences between male and female patients.
Material and methods. We report the case of a 73 years old female patient known with ischemic left pontine
stroke and grade 2 bilateral coxarthrosis, associated with systemic arterial hypertension and type 2 diabetes
mellitus insulin dependent. Her symptoms on admission were walking deficit, right limbs motor impairment,
right shoulder stiffness and knee and hip pain.
Results. At presentation: BMI=32, BP= 120/70 mmHg, HR= 68 bp, ECG: sinus rhythm, minimal diffuse
ischemic changes. Musculoskeletal system revealed: Asworth scale=2 in the right limbs, right deep tendon
hyperreflexia, skeletal muscle force in the right upper limb= 1/5 right lower limb= 4-/5, right prehension
deficit, right shoulder subluxation grade 2/3, Babinski sign (+) on the right, positive left test Patrick, left
limited rotation in femoral neck in all axes, right spastic walk, Barthel index= 40. Lab work: nonspecific
inflammatory syndrome, otherwise unremarkable. X-ray pointed out advanced coxarthrosis on the left. The
patient was informed about her actual status and we explained her options at this point. She fervently refused
the surgical procedure for hip replacement and expressed her wish for conservatory treatment. The
rehabilitation adapted program for her status was antalgic electrotherapy, neuromuscular stimulation,
occupational therapy, exercise therapy and application of orthosis.
Conclusions. This was a difficult case by all the means: elderly patient weakly motivated, advanced multiple
comorbidities and express refusal of certain procedures.
The physical rehabilitation and applied medication of such patients require social, economic, medical and
family support which may lead to some improvement in their quality of life and emotional/ cognitive status.
L56
L57 - Rehabilitation Limitations and Approaches in Obese Patients
Mihaela Ramona PĂCURAR1,2, Dănuţ PĂCURAR1,2
Corresponding author: Dănuţ PĂCURAR, E-mail: icu_dan@yahoo.com
1. University of Oradea, Faculty of Medicine and Pharmacy,Oradea, Romania
2. Carei County Hospital
Abstract
Introduction. Obesity is defined by World Heart Organization as an excessive fat accumulation that presents
a risk factor to health. A patient with a BMI of 30 or more is generally considered obese. Obesity is in fact a
disease of epidemic proportions and a major concern worldwide.
Material and methods. We present the case of a 52 years old male patient known with surgical intervention
(vertebroplasty with acrylic cement) for post-traumatic eight dorsal vertebra fracture. He was hospitalized in
our department for: chronic intense pain in cervico-dorso-lumbar spine with radiculopathy and poorly
controlled systemic arterial hypertension.
Results. On admission: BMI= 41, BP= 150/90 mmHg (on chronic BP lowering drugs), HR= 92 bmp, SO2=
97%. Clinical findings were rhythmic heart sounds with no murmurs and no crackles, mild kyphoscoliosis,
painful lumbar flexion, dorso-lumbar paravertebral muscular contraction and hypersensitivity percution and
cervical limited motion in all axes. Lab work: hyperuricemia and moderate dyslipidemia. ECG and
transthoracic echocardiography revealed hypertensive heart profile. MRI confirmed the above-mentioned
diagnosis, without other pathological findings. We adjusted his BP treatment and carefully monitor BP
fluctuation and then start the rehabilitation program. Every session of rehabilitation therapy began with
psychological counseling to highlight the importance of obesity in his comorbidities and the impact on
medium- and long-term prognosis. After 2 years his clinical status significantly improved: he is very active,
with only mild spinal pain, BMI is 30.2, BP is normal without antihypertensive medication, uric acid is within
normal ranges with mild hypertriglyceridemia.
Conclusions. Evidence based medicine on how to rehabilitate obese patients is weak. At the moment there
are no specific guidelines for rehabilitating patients with obesity and comorbidities so further comparative
trials are needed.
L57
L58 - Physiotherapeutical treatment used in the rehabilitation of polymyositis
Rucsandra Nedelcu1, Catalin Ionite1*, Iustina Condurache1, Mariana Rotariu1
Corresponding author: Catalin Ionite: catalin.ionite@yahoo.com
1
University of Medicine and Pharmacy „Grigore T. Popa”, Street University, No. 16, Iași, România
Abstract.
Introduction
Polymyositis is described in speciality literature as an inflammatory disease that causes generalised muscle
weakness, making it difficult or imposible to climb stairs, rise from a seated position, lift objects or even stand
for a long time. This disease most commonly affects adults in their 30s, 40s or 50s, women being affected
more often than men, and signs and symptoms usually develop gradually, over weeks or months.
Materials and method
This study included a group of 15 subjects, diagnosed with polymyositis by a specialist. The group went
through two evaluations, an initial one, before the rehabilitation protocol was applied, and a final one.
The study lasted for a period of six weeks, from January 2020 to March 2020. During that period, each pacient
received four treatment sessions per week, reaching a total of 24 sessions.
Each session focused on a combined therapeutical protocol that included massage (effleurage,tapotement),
electrotherapy (Trabert, TENS, interferential current) and physiotherapy (exercises for muscle relaxation,
passive and active mobilisation and neuroproprioceptive facilitation techniques).
Results
According to the results obtained from subsequent evaluations (initial and final), and afterwards compared, a
significant improvement in muscle tone was obtained, a parameter directly proportional to the muscular
strength of the patients, which also registered an increase. The increase of the two parameters led to the
improvement of the patient's functionality in performing daily activities for a longer period of time.
Conclusion
The results obtained and compared with each other, suggest that the treatment protocol designed and applied
in the rehabilitation of patients diagnosed with polymyositis, had positive effects, increasing muscle tone and
muscle strength, restoring the patient's functionality, including his autonomy.
Key words: polymyositis, rehabilitation protocol, functionality.
L58
L59 – Clinical-Imagistic and Recuperative Features in a Young Patient who is
Traumatized by Road Accident- With Vegetative State and Evolution Towards a State of
Minimum Consciousness at 6 months after the accident
Simona-Isabelle STOICA1,2, Carmen Elena CHIPARUS2, Magdalena Vasilica LAPADAT2, Iulia- Maria
NOHAI2, Andreea DUMITRASCU2, Ioana ANDONE1,2, Gelu ONOSE1,2
Corresponding author: Simona-Isabelle STOICA, E-mail: stoicasimonaisabelle@yahoo.com
1. University of Medicine and Pharmacy “Carol Davila” (UMPCD), Bucharest, Romania

2 Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
Abstract
Introduction. The frequency of road accidents is increasing due to technological progress and unpredictable
elements (state of the roads, individual factors, and so on). And the individual consequences can be very
severe.
Materials and Methods. With the permission of the TEBA Ethics Committee (no 3159/ 30.01.2019), we will
present an interesting case of a young patient who suffered a severe head injury after a road accident. We will
talk about the evolution of clinical, paraclinical and functional parameters. We will also highlight the
diagnostic and therapeutic features encountered in this case.
Results. Despite the unfavorable clinical and functional prognosis and the multiple post-traumatic
complications that occurred, the patient survived and evolved to better psycho-cognitive and functional states.
Conclusions. Road accidents represent a real social problem through individual, family and professional
consequences. In this context, primary and secondary preventive education of the population, as well as the
promotion of neuro-muscular recovery programs are essential.
L59
L60 - Favorable Evolution in a Case of Right Hemiplegia and CFP with Medium to Severe
Crural Motor Deficiency and Predominantly Mixed Expressive Aphasia, After a Voluminous
Profound Intraparenchymatous Hematoma Located In The Left Temporal Lobe, Which Was
Surgically Removed.
Alexandru G. STAVRICĂ2, Mihaela MANDU2, Cristina POPESCU2, Gelu ONOSE1,2
Corresponding author: Alexandru G. STAVRICĂ, E-mail: alexandru.stavrica@gmail.com
1. "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania

2. Neurorehabilitation Clinic, Teaching Emergency Hospital ”Bagdasar Arseni” (TEHBA) Bucharest, Romania
Abstract
Introduction. An intra-parenchymatous hemorrhage is a blood accumulation that occurs in the cerebral
parenchyma, most commonly situated in the temporal or parietal lobe, but can occur at any level of the cerebral
hemispheres.
The mechanism of formation of a hematoma is represented by the rupture of a blood vessel, which can be
produced by multiple factors, the most known being CBT, hemorrhagic stroke or cerebrovascular
malformations.
The neurological manifestations may develop suddenly or slowly (within a few days). These depend on the
location of the hematoma and can affect speaking, sensitivity, mobility or even the mental condition.
The evolution of the patient depends firstly on the location and the volume of the hematoma, but, of course,
also on age or other associated diseases. It may spontaneously recovery or may require neurosurgical
intervention.
Case presentation. 30 years old male patient with right hemiplegia and CFP - with medium-severe crural
deficit and mixed aphasia, predominantly expressive, after deep, voluminous left intraparenchymatous
hematoma (operated on 27.11.2019 - evacuation and left frontal-temporal decompression with flap).
Neurogenic bladder - carrier of indwelling urinary catheter. UTI etiologically treated. Secondary HBP, was
admitted to the Neuromuscular Recovery Clinic of the Emergency Clinical Hospital "Bagdasar-Arseni"
(TEHBA) for right hemiplegia motor deficit, right CFP, severe locomotor and auto-care dysfunctions,
retention sphincter disorders (neurogenic bladder) and specialized recovery and nursing treatment, with
favorable evolution.
Discussions. The peculiarity of this case consists in the good evolution of a patient with voluminous temporal
hematoma and, especially, the means of production of the hematoma, given the young age of the patient, the
problem of a cerebrovascular malformation is raised.
Keywords: hematoma, hemiplegia, decompressive flap, recovery
L60
L61 - Neuroped-Rehab – A New Platform for Children and Youth with Acquired Brain
Injury
Maria Veronica MORCOV1, Liliana PADURE1,2, Corina SPOREA1
Corresponding author: Corina SPOREA, E-mail: corina.sporea@gmail.com
1. National University Hospital for Children Neurorehabilitation “Dr. Nicolae Robanescu”, Bucharest, Romania
Abstract
Introduction. Acquired brain injury (ABI) is a brain injury that occurs in a child who previously had a normal
development.
ABI most frequently includes head injury (from mild to severe), brain tumors, and strokes. Other causes are
infectious (meningoencephalitis, meningitis), anoxic (cardiac arrest, drowning, hypoxia of various origins),
autoimmune or inflammatory. Traumatic brain injuries, part of ABI, are a major public health problem and
are the main cause of death and disability in children and adolescents.
Materials and methods. Since 2017, 5 European partners from Romania, France (2) and Denmark (2) met
and shared their experiences in a interdisciplinary cooperation in rehabilitation of children and youth with
ABI. They wanted to share their expertise and to offer, in an innovative way, common clinical practices
applicable as directly as possible in the hospital and after discharge, in the continuous development phase.
Results. As a result of their joint efforts, they developed a guideline for best practices in rehabilitation of
children and youth with ABI (that contains 24 standard procedures for rehabilitation) and an e-Learning
platform.
Conclusions. The e-Learning platform and the guidelines for modern interdisciplinary rehabilitation practices
for children and youth with acquired brain injury turned out to be useful tools for professionals working in the
field of pediatric neurology, neuro-physiology and neuro-pedagogical rehabilitation of children and young
people: residents or specialists in rehabilitation, physical therapists, psychologists, occupational therapists,
speech therapists, orthoptists.
Keywords: acquired brain injury, pediatric rehabilitation, e-Learning, best practices, guidelines
L61
L62 - Favorable evolution on functional key components but with multiple remaining
phatological elements in a patient diagnosed with toraco-lombar SCI
- Case report –
Irina Raluca PETCU3, Florin DELCEA³, Dumitru Cristinel BADIU1,2, Mihaela MANDU2,
Gelu ONOSE1,2
Corresponding author: Irina Raluca PETCU, E-mail: varsa_raluca@yahoo.com
1. University of Medicine and Pharmacy Carol Davila (UMPCD), Bucharest, Romania,

2. Teaching Emergency Hospital Bagdasar Arseni (THEBA), Bucharest, Romania.
3. Municipal Hospital of Turnu Magurele, County-Teleorman, Romania.
Abstract
Introduction: This paper presents an extremely complex case: paraplegia with T11 neurological level post-
thoracic lumbar TVM with T12 commutative fracture by falling from about 2 meters (operated 17.02.2020),
currently having a motor deficit AIS / Frankel C with multiple complications and successive worsening, as
well as the approach of its therapeutically-rehabilitation management, respectively.
Materials and methods: 41-year-old male patient admitted in our Clinic s Division for motor deficiency
of paraplegia type immediate postoperative Frankel C- currently AIS / Frankel D, superficial sensitivity
disorders with T11 level. The patient was clinical and functionally evaluated, according to the standard
implemented protocols of our Unit , through the following measurement evaluation scales: AIS, FIM, QQL
(Quality of life), Ashworth, Penn, FAC, WISCI II, and investigate paraclinical). During the admission, the
patient has numerous aggravations and complications such as; urinary tract infection with E. Coli; left
epididymo-orchities ; all of which aggravate / delay, the therapist-recovery procedures / results.
Results: Following optimal treatment including pharmacological, and complex neuro-rehabilitation program
the patient had a favorable evolution with increased values of the measurement scales (motor AIS with 13
points, FIM motor with 5 points, QQL with 9 points, and FAC with 1 point );incomplet remission of bladder
and neurogenic bowel dysfunction (intermittent the urinary catheter ); increased muscle strenght with
improved walking speed and balance.
Conclusion : The recovery of patients with spine-cord injury is a complex process,which requiers taking into
account all associated pathologies that can play a decisive role in the evolution of the patient.
A multidisciplinary team is required for such purposes
Keywords: spine-cord injury, poly-pathologic, rehabilitation
L62
L63 - Case Report: Neuromuscular Successful Rehabilitation Approach in a Case of a
Surgically Removed Cervical Ganglioneuroma with Favorable Outcome Results
Mihai BĂILĂ, Cristina Octaviana DAIA1,2, Daniel ȘERBAN2, Ioana ANDONE1,2, Cristian
RADUCANU2, Mihalea MĂNESCU2, Gelu ONOSE1,2
Corresponding author: Mihai BĂILĂ, E-mail: baila_mihai@yahoo.com
1. University of Medicine and Pharmacy Carol Davila (UMPCD), Bucharest, Romania,
2. Teaching Emergency Hospital Bagdasar Arseni (THEBA), Bucharest, Romania.
Abstract
Introduction. Neural crest cell tumors are rare tumors with a dense nomenclature. In this family of tumors
are included tumors derived from sympathoadrenal (SA) cells. The Ganglioneuroma (GN) is considered to
be a benign tumor of the SA.
Material and methods. In this report we describe the case of a 52-year-old male with a spinal cord
compression syndrome caused by a left cervical (C1-C2) ganglioneuroma (GN), resulting in spastic
tetraplegia, Brown-Sequard syndrome, mild restrictive ventilatory impairment, neurogenic bladder and gut.
The tumoral process has been surgically removed and the patient followed a splitted rehabilitation program
for almost 4 months, benefiting in this time from rehabilitation nursing, a physical therapy program and
medical therapy.
Five assessment scales were registered on the hospitalization admission and on discharge and served for the
quantitative analysis of the patient s neuro-myo-arthro-kinetic status: FIM (Functional Independence
Measure), FAC (Functional Ambulation Categories), ASIA impairment scale, modified Ashworth scale,
Penn scale , Barthel Index for Activities of Daily Living. This study has approval of the Ethics Commission
of the Teaching Emergency Hospital „Bagdasar-Arseni”, nr 3159 of 30.01.2020.
Results. The rehabilitation program improved the patient’s muscle strength and muscle control, with
supplementary increase of muscle tone. The bladder and bowel continence were regained. The patient has a
persistent right hemianesthesia. The scales that quantify the clinical status and the autonomy of the patient
improved significantly.
Conclusions. Ganglioneuromas most frequently have a benign evolution and usually occur in children.
Tumors with the origin in the paravertebral sympathetic ganglia are most often found incidentally. The
treatment of ganglioneuroma is surgical excision and post-operative monitoring of the disease progression.
In this case of ganglioneuroma with cervical localization occurring at adult age, the patient has a consistent
favorable neuromuscular recovery following complete surgery.
L63
L64 - PREVENTION OF LUMBAR DISC HERNIATION IN YOUNG ADULT POPULATION –
COLLECTING DATA FOR THE AWARENESS CAMPAIGN
Doroteea Teoibas-Serban1, Liviu Iordache1, Valentin Stan2, Dan Blendea1,3
Corresponding author: Doroteea Teoibas-Serban: doroteeateoibas@yahoo.com
1.Clinical Regional Emergency Hospital Ilfov Bucharest, Romania

3. Univeristy of Medicine “Titu Maiorescu” Bucharest, Romania
Abstract.
Introduction: Our previous paper discussed the increasing number of young adult population with lumbar disc
herniation in the past few years. Most of the patients who seek medical attendance are young healthy male
adults. They workout at the gym for a variety of reasons such as weight loss, muscle toning and increasing
muscle mass. They are either unaware of the risk that certain exercises involve, or they wish to get faster results,
obtaining the opposite effects. Thus, many of them develop lumbar disc herniation at a young age and must
maintain certain restraints in order to stop it from evolving or reoccurring. The ideal solution is to increase
awareness at the already numerous young male population who frequents the gym to prevent disc herniation.
Materials and Methods: The next step for our awareness campaign is to collect data directly from the source. A
carefully created questionnaire with specific questions related to general knowledge, way of training and
individual research on the topic was given to young adult males in many gyms from Bucharest. The
questionnaire was completely anonymous and targeted young adult males which had to respond truthfully and
give away only their age.
Results: The statistics show that most of the responders to the questionnaire did know about lumbar disc
herniation and the risk involved in exercises such as weightlifting but did not possess the proper knowledge of
how to do certain movements in order to prevent it.
Conclusion: The data collected showed that most of the young male adults which frequent the gym are not fully
prepared with enough knowledge in order to do certain exercises without risking lumbar disk herniation. We
must continue our campaign of awareness in this category of population in order to reduce the number of young
patients with this disease.
L64
L65 - Neurofilaments - Biomarkers in Severity Assessment and Evolution
of Pediatric Patients with Spinal Amyotrophy
M. BADINA1, A. MIREA1,2, M. BEJAN1, S. SHELBY1, M. AXENTE1, M.C. LEANCA1,

L. PADURE1,2
Corresponding author: M. BADINA Email: mihaela.badina@yahoo.com
Abstract
Introduction. Neurofilaments are structural components of the neuronal cytoskeleton, found only at this level,
that, in case of perikaryal/ axonal lesions, are released into extracellular fluid and can be detected in blood and
cerebrospinal fluid. Affecting the integrity of neurons within different pathologies, the level of neurofilaments
correlates directly proportional to the degree of injury. Spinal amyotrophy is characterized by muscle atrophy
due to loss of motor neurons as a result of inefficient and insufficient synthesis of the survival motor neuron
(SMN) protein, involved in the regulation of transcription, regeneration of telomerases and cellular active
transport.
Materials and methods. We performed a literature study of published reports by different clinical trials on
neurofilaments level in blood and CSF in different disorders that evolve with neuronal lesions and the
correlation of this level with evolution and response to treatment.
We included in our literature review only ISI Thomson articles and clinical trials published reports on
neurofilaments in neurologic diseases from the last decade.
Results. Increased amounts of neurofilaments appear in the CSF and blood in various diseases characterized
by neuronal damage and degeneration, and the degree of neuronal damage correlates with the plasma and
spinal levels of these proteins.
Conclusions. The level of neurofilaments can be an important disease evolution indicator, showing the
response to treatment in pediatric patients with spinal amyotrophy, too.
L65
L66 - NEW THERAPIES IN SPINAL MUSCULAR ATROPHY
A. MIREA1,2, S.SHELBY2, MC. LEANCA2, L. PADURE1,2, G. ONOSE1,3

Abstract. 3. Teaching Emergency Hospital “Bagdasar-Arseni”
Introduction. Spinal muscular atrophy (AMS) affects motor neurons in the anterior medullary horn, with consequent loss
of muscle mass and the installation of motor deficiency. Most cases are caused by the homozygous deletion of exon 7 of
the SMN1 gene, but there are other bialelelic mutations in this gene that may be responsible for this disease. (1) At present,
in Romania, only one substance - Nursinersen - is approved for its treatment. SMN2 gene is paralogous to SMN1 (2) and
differs from it by several nucleotides including CT substitution at position 6 of exon 7 (3,4,5,6), which interferes with a
splicing enhancer in exon 7 (ESE) (1). Along with a splicing of the intron 7 template called ISS-N1, disruption of this
ESE results in the removal of exon 7 during the splicing process in most transcripts, resulting in an incomplete, non-
functional SMN protein - Δ7SMN2. (1,3,4,5,6)
Nursinersen acts on the mechanisms of pre-messenger RNA, shading by hybridization with ISS-N1 and competition with
the splicing factor hnRNPA1, which recognizes ISS-N1, thus increasing the level of complete SMN2 transcripts and thus
the total level of SMN protein. (1.6)
In the United States, a second drug - Onasemnogene abeparvovec (Zolgensma) - is recommended for all patients with
AMS up to 2 years of age. It is the associated adenovirus (AAV9) that contains SMN1 transgene and has the ability to
cross the blood-brain barrier and can be systemically administered. (7)
In addition, for the substance in phase 3 clinical trials - Risdiplam - there is documentation submitted for approval to be
marketed at European level. Risdiplam is a small molecule, which is administered orally and distributed in the central
nervous system and peripheral organs. (8) This compound blocks the interaction with the MDR1 transport protein (human
multidrug resistance protein) and prevents splicing of exon 7 of the SMN2 gene, increasing the amount of complete SMN
protein. (9) There are, therefore, 3 substances, disease modifiers in the case of AMS pathology, with each one regarding
the administration (intrathecal, intravenous and per os).
Material and Methods. We conducted a literature study of published results of phase 3 clinical trials for each of the three
substances mentioned above.
Results. None of three substances presented above heals. They only stop disease’ evolution and, depending on the time
of initiation of the therapy, can generate the recovery of the motor function to a lesser or greater extent.
Conclusions. Initiation of drug therapy in SMA should be performed as soon as possible after the diagnosis is confirmed.
Ideally, patients should be treated symptomatically.
1. Briefing Document to the Clinical Trial Readiness in Spinal Muscular Atrophy (SMA) SMA Europe, TREAT-NMD and
European Medicines Agency meeting November 11, 2016, EMA, London, UK
2. Tosolini AP, Smith GM. Gene Therapy for the Central and Peripheral Nervous System. Frontiers Media SA. ISBN: 978-2-
88945-475-4, ISSN: 1664-9714.
3. Wurster CD, Ludolph AC. Nursinersen for spinal muscular atrophy. Ther Adv Neurol Disord. 2018. 11: 1756285618754459
4. Singh NK, Singh NN, Singh RN. Splicing of a Critical Exon of Human Survival Motor Neuron Is Regulated by a Unique Silencer
Located in the Last Intron. Mol Cell Biol . 2006. 26(4): 1333-1346.
5. Singh NN, Androphy EJ, Singh RN. The regulation and regulatory activities of alternative splicing of the SMN gene. Crit Rev
Eukaryot Gene Expr. 2004. 14(4): 271-85
6. Ju-Jin Qu, Jin-li Bai, Fang Song. A rare variant (c.863G>T) in exon 7 of SMN1 disrupts mRNA splicing and is responsible for
spinal muscular atrophy. 2016. 24(6):864-70.
7. Armbruster N, Lottanzi A, Buj-Bello A. Efficacy and biodistribution analysis of intracerebroventricular administration of an
optimized AAV9-SMN1 vector in a mouse model of spinal muscular atrophy. Mol Ther Methods Clin Dev. 2016. 3:16060.
8. Poirer A, Weetall M,Heinig K, Bucheli F, Schoenlein K, Alsenz J, Bassett S, Ullah M, Senn C, Ratni H, Nanyshkin N, Paushkin
S, Mueller L. Risdiplam distributes and increases SMN protein in both the CNS and peripheral organs. Pharmacol Res Perspect.
2018. 6(6): e00447.
9. Chiriboga CA. Risdiplam – SMN2 splicing modulator, treatment of spinal muscular atrophy. Drugs Fut 2019. 44(8): 643.
L66
L67 - Proprioceptive Focal Vibratory Stimulation in Vegetative State Bedridden Pediatric
Patients after Traumatic Brain Injury
Andra PINTILIE¹, Liliana PĂDURE¹
Corresponding author: Andra PINTILIE, E-mail: andra.pintilie@gmail.com
1 Pediatric Neuro-psycho-motor Rehabilitation National Teaching Centre “Dr. N. Robanescu”
Abstract
Introduction. Traumatic Brain Injury (TBI) is defined as an alteration in brain function as a result of an
external force either involving impact to the head (traumatic impact) or inertial forces (traumatic inertial).
Severe TBI is a heterogeneous group of symptoms compiled of motor impairment to cognitive, speaking,
memory, focus, behavioral alternations.
Materials and Methods. Our interest was to observe the evolution of consciousness, responsiveness and
awareness in a TBI patient with vegetative state, using proprioceptive focal vibratory stimulation (PFVS).
We present the case of a 15 y.o. female patient with TBI following a height fall (over 15 m) a month prior to
admission to our rehabilitation unit.
The physical examination discloses a vegetative state, with motor impairment to all four limbs, accompanied
by high intensity spasticity and contractures, bladder and bowel incontinence, with vital signs in normal
ranges.
She was prescribed a complex neurorehabilitation program, including physical therapy for maintaining and
improving ROM, spasticity decrement, neurosensory stimulation and robotic controlled standing training.
PFVS was applied to all four limbs, in order to stimulate proprioception, neuroplasticity, maintain and
reestablish neurological gateways, for a duration of 20 minutes per day, during several hospital admissions.
Results. Although still bedridden with severe neurological impairment, an improvement in patient’s
vegetative state was noticed, evolving to minimal conscious state.
Conclusions. Regarding the apparent small achievement, PFVS is applied to each TBI patient in our
neurorehabilitation unit, in order to observe and assess the consciousness’ state evolution.
L67
L68 - Lung Ventilation Monitoring in Patients with Spinal Amiotropy Type
A.MIREA1,2, MC. LEANCA2, FP. GRIGORAS2, L.PADURE1,2, G.ONOSE1,3
Corresponding author: Andrada MIREA, E-mail: andrada.mirea@gmail.com

Abstract
Introduction. Spinal Muscular Atrophy (SMA), affects motor neurons in the anterior medullary horn, often
those in the brainstem, leading in time to their apoptosis and muscle loss(1). Because of breathing involved
muscles impairment, pulmonary ventilation is also affected patients with type I SMA requiring non-invasive
bi-level positive pressure ventilation (BIPAP) (2).
Material and Methods. 12 patients with type I were evaluated: 7 girls and 5 boys. Of these, 8 (4 girls and 4
boys) received BIPAP indication and used it appropriately. Of these, 1 patient is ventilated on the
tracheostoma. CO2 levels were monitored with transcutaneous sensor (with / without non-invasive
ventilation) and evolution of thoracic circumference was compared to cranial perimeter during a minimum
of 9 months. Different ventilation pressures were used, depending on the needs of each patient (evaluated by
capnograph titration), but all were aimed at maintaining a CO2 level between 30-40 mm Hg, without
exceeding 10 mm Hg between the measured CO2 values in sleep and watch.
Results. Patients showed a corresponding increase in the thoracic circumference, related to both the cranial
perimeter and the normal value for age.
In addition, chest development in noninvasively ventilated patients was similar to those that did not require
ventilation.
Conclusions. The correct use of non-invasive ventilation offers the possibility of adequate lung expansion
and development of a corresponding thorax volume.
References
1.Mercuri, E., Finkel, R. S., Muntoni, F., Wirth, B., Montes, J., Main, M., ... & Bertini, E. (2018). Diagnosis and management of spinal muscular
atrophy: part 1: recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscular Disorders, 28(2), 103-115
2.https://www.curesma.org/wp-content/uploads/2019/07/breathing-basics.pdf
L68
L69 – Current Aspects Regarding “Smart Homes”/ Ambient Assisted Living (AAL)
Including Afferent Instrumental Activities of Daily Living (IADL) Specific Devices, for
People with Disabilities/ Special Needs
Ioana ANDONE1, Aura SPÎNU1, Cristina POPESCU1, Simona STOICA1, Liliana ONOSE3, Gelu ONOSE1,2
Corresponding author: Ioana ANDONE, E-mail: ioanaandone11@yahoo.com
1. The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania

2.The University of Medicine and Pharmacy “Carol Davila” (UMPCD), Bucharest, Romania
3.The Medical Service of Metrorex SA, Bucharest, Romania
Abstract
Introduction. The population life expectancy has increased (“over half the EU’s population predicted to be
over-65 by 2070”), according to recent prevalence studies, being a result of the advancement of technology
and medical science. This ageing population has implications on the society, because there is increased number
of older people requiring better quality of life.
Materials and Methods. AAL represents the systems that may support completely the living area of a person
and has the potential to facilitate the elderly to live longer and more safety in their family environments,
allowing them to continue their current activities, facilitating participation in more activities at home and in
the community and improving the cost-effectiveness and quality of health and social services. A practical use
of technology is the introduction of home networks, which involve notions such as: "smart homes ", “tele-
health / tele-care” and even, possibly, “tele-medicine” to allow people with serious illnesses / conditions / and
special needs to maintain an appropriate quality of life (QOL) at home.
Discussions and Conclusions: AAL can contribute to an increased autonomy, self-confidence, and mobility
in people whose activity is limited to home environment, such as "the oldest olds” and/ or those with severe
neuro-/ loco-motors disabilities, and so to reduce the risk of institutionalization, enhance security, prevent
social isolation, thus allowing “older adults to age in place”. An important role in achieving this goal is
representing by working in a multidisciplinary team (experts in the field of health - rehabilitation, gerontology
-, social experts, technical/ informatics experts, engineering and robotics experts).
Key words: ambient assistive living, quality of life, special needs, tele-medicine
Selected bibliography:
1. http://www.aal-europe.eu/about/
2. Edge M, Taylor B, Dewsbury G & Groves M (2000) 'The potential for 'smart home' systems in meeting
the care needs of older people with disabilities, Seniors' Housing Update, Gerontology Research Centre,
Canada, Vol10, Number 1, August 2000, pp:6-7, ISSN: 118-1828
L69
L70 - Complex Clinical, Paraclinical and Neurological Rehabilitation Approach of a Patient
with Confusional Psycho-Cognitive Status After A Ruptured Posterior Communicating
Artery Aneurysm, with Fronto-Parietal Bone Flap and Internal Hydrocephalus
George PĂTRAȘCU1, Ali Osman SAGLAM1, Laura POPESCU1, Luminița Nirlu1,

Ana Carmen REBEDEA1, Alexandra SPORICI1, Gelu ONOSE1,2
Corresponding author: George PĂTRAȘCU, E-mail: george.ptr.93@gmail.com
1. Teaching Emergency Hospital „Bagdasar-Arseni” Bucharest (TEHBA)
2. University of Medicine and Pharmacy “Carol Davila” in Bucharest, Romania
Abstract
Introduction. Cerebral aneurysm is a cerebrovascular disease where the weakness of the arterial wall
produces abnormal dilatations of it. The cause could be congenital, determined by infections (mycotic
aneurysm), or determined by vascular modifications in arterial hypertension. The most frequent location of
the aneurysms is in the circle of Willis. The patient with ruptured aneurysm needs neurological rehabilitation
on long term, physical therapy, occupational therapy and re-education of speech.
Materials and methods. This paper presents a case of a 41 year old patient known with history of lumbar
polydiscopathy and cervical discopathy, who suffered an aneurysm rupture of the posterior communicating
artery complicated with subarachnoid hemorrhage Hunt and Hess III, internal hydrocephalus, cerebral
vasospasm, intracranial hypertension syndrome, sphincter incontinence, locomotor dysfunction and
confusional psycho-cognitive status.
The patient was initially admitted in the Neurosurgical department of National Institute of Neurology and
Neurovascular diseases, where, after clinical and paraclinical evaluation, the above diagnostic was established
and surgical intervention was performed, practicing aneurysm clipping, fronto-parietal bone flap and unishunt
ventricular drain.
In our clinic, the patient followed an adequate medical and physical treatment. The patient was functionally
assessed using the following scales: Glasgow Outcome Scale, Mini-Mental State Examination, Montreal
Cognitive Assessment, Modified Rankin Scale, Modified Ashworth, Functional Independence Measure, FAC
International Scale, Quality of Life Assessment.
Results. The complex neurological rehabilitation and nursing treatment, together with medical treatment,
psychiatric and psychological evaluation and counseling, led to a favorable evolution, the patient being to
walk on relatively long distances under surveillance of another person, climb and go down the stairs with
moderate assistance and the confusional elements being on easy regression.
Conclusions. The complexity of the case consists in favorable evolution of a serious neurological lesion, this
being possible due to disorder and excellent interdisciplinary collaboration.
P70
L71 - Plantar support - possibility to evaluate the patient, THERAPY AND MANUFACTURE OF
FOOT ORTHOSES
Florin Dragan1, Liliana Padure1,2, Gelu Onose2,3
1. CNCRNC Dr. Robanescu,

2. UMF Carol Davila
3. SCUBA
Abstract.
Introduction. The plantar support represents the contact of the foot with the support surface, highlighted in our
Center- CNCRNC Dr. Nicolae Robanescu by the RSSCAN device 7 seccond generation 2 m plate with 16,000
sensors, in static (orthostatism) and dynamic (walking) support situations. The software of the device can
interpret the manifestation of the foot on the support surface and recommend personalized plantar supports on
each case. The plant is the body's landmark for walking as it is like the foundation of the house.
Material and method: The group of ambulatory patients from our Hospital, who have the obligation to evaluate
the plantar support, because we wanted to see this from the beginning in order to make ADEQUATE
PLANTING SUPPORTS.
Results: The association of custom-made plantar supports is an appropriate therapeutic addition, which helps
to recover the leg with deformities, to supplement the trunk orthosis, of sight.
Conclusions: From the observation of our patients we saw how the plantar support is influenced by the wearing
of glasses, the corset (which passively reduces the Cobb angle by 10 degrees on average) of the braces / braces.
Keywords: Plantar support, Cheaneu corset, plantar supports.
L71
L72 - CHANGES OF SPIROGRAPHIC AND HEART RATE VARIABILITY PARAMETERS AFTER
RESONANT BREATHING EXERCISE TRAINING
Matei Daniela, Luca Catalina, Fuior Robert, Sardaru Dragos, Corciova Calin
Corresponding author: Matei Daniela
Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of
Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania
Abstract.
Background: Breathing at resonance frequency, approximately 6 breaths/min (6BPM) is hypothesized to be a

pathway through which we can improves heart rate variability (HRV). Higher levels of HRV are indicative of
a healthy heart and low HRV predicts cardiovascular mortality and morbidity.
Objectives: The aim of the study was to evaluate the relantionship between HRV parameters and the pulmonary
functions befor and after a program training consist of breathing exercise at near resonant frequency (6 BPM).
Methods: 20 non-smoking subjects without respiratory problems (age, 21.7±1.4 years) were randomly assigned
(1:1) to the program training (PT, n=10) or control (CG, n=10) group. We measured height, weight, body mass
index and computerized spirometry parameters: forced vital capacity (FVC), forced expiratory volume in 1 sec.
(FEV1), peak expiratory flow (PEF), maximal expiratory flow at 50% of vital capacity (MEF50). Time-domain
indices of HRV such as mean RR, square root of the mean squared differences of successive normal to normal
intervals (RMSSD), standard deviation of normal to normal interval (SDNN), and the proportion derived by
dividing NN50 by the total number of NN intervals (pNN50), were calculated. Using Fast Fourier Transform
(FFT) we analyzed frequency domain indices, low-frequency (LF) and high-frequency (HF) powers, LF/HF
ratio. The subjects were reassessed after a training period of 10 minutes a day, 5 days a week for a month.
Results: The study has shown a statistically significant decrease of LF/HF ratio with p<0.03 and increase of HF
(p<0.01). The training program significantly augmented the level of FEV1 (p<0.04), MEF50 (p<0.05) as
compared with their own baseline. Also, there was a significant correlation between HRV changes and the
augmentation of respiratory performance in students receiving the training program.
Conclusions: Our findings indicated that 1 month of 6 BPM training can increase parasympathetic activity and
lung function.
L72
L73 - Analgesic and Anti-Inflammatory Potential of Artemisia Extracts on Experimental
Models of Nociception
Bianca IVĂNESCU1, Andreia CORCIOVĂ1, Laurian VLASE2, Ana-Maria GHELDIU2,
Anca MIRON1, Daniela Carmen ABABEI1, Veronica BILD1
Corresponding author: Bianca IVĂNESCU, E-mail: biancaivanescu@yahoo.com
1“Grigore T. Popa” University of Medicine and Pharmacy, Faculty of Pharmacy, Iași, Romania,
2“Iuliu Hatieganu” University of Medicine and Pharmacy, Faculty of Pharmacy, Cluj-Napoca, Romania
Abstract
Introduction. The study aims to assess the antinociceptive and anti-inflammatory activity of extracts obtained
from indigenous species of wormwood: Artemisia absinthium, A. annua, A. vulgaris and A. pontica.
Materials and methods. For these experiments, we employed nociception models using thermal stimulus (hot
plate and tail immersion tests, t = 52.5 0C; 30, 60 and 90 minutes testing), chemical stimulus (Zymosan-
induced abdominal constriction response test, using distinct lots and testing at 60, 90 and 120 minutes after
administration of samples) and pressure stimulus (Randall Sellito test) and an inflammation model for the
evaluation of inflammatory edema by Plethysmometer test. Groups of 6 Swiss mice / lot were used, receiving
by oral administration the plant extracts suspended in 0.1% CMC-Na. The doses were administered in
geometric progression.
Chemical analyses were performed by HPLC-MS in order to identify bioactive substances present in extracts:
metoxylated flavonoids, sesquiterpene lactones, phytosterols and hydroxycinnamic acids.
Results. All plant extracts showed antinociceptive action on the models with thermal stimulus, as
demonstrated by the ED50 values obtained at different test times. In the models of nociception with chemical
and mechanical stimulus, models based on inflammatory mediation, the studied fractions have partially proved
their antinociceptive action. Regarding the degree of inhibition of inflammatory edema, the highest potency
was exhibited by Artemisia pontica extract (86.5% inhibition for the dose of 100 mg/kg). Hispidulin and
eupatorin, known anti-inflammatory compounds, were identified in all extracts, along with caffeic and
chlorogenic acids, stigmasterol, campesterol and β-sitosterol.
Conclusions. The obtained results support the use of these plant extracts in moderate intensity pain, triggered
by both central and peripheral mechanisms.
L73
L74 - The Efficacy of Covasna Natural Factors in the Treatment of Chronic Diseases
Yuliya MANOLAKI1, Andrei Stefan BICHIS1, Lucia TURSAN1
Corresponding author: Lucia TURSAN, E-mail: tursan@turismcovasna.ro
1 S.C. Turism Covasna
Abstract
Introduction. Covasna is an all-season spa and climatic resort for the treatment of cardiovascular diseases,
situated at the foot of the western side of the Bretcu Mountains. It is the town of mofettes and mineral waters,
with an intramountain depression climate, protected from strong currents and winds by the nearby forested
ridge. The Covasna mineral waters are carbonated waters, with a bicarbonate, iron, sodium chloride, iodine-
bromine, arsenic or slight sulfur content, rich in carbonic acid of volcanic origin. The mineral waters are used
both internally and externally (CO2 baths).
Objective. To study the pharmacodynamic action of the Covasna F3 mineral water for internal treatment.
Material and method. The study was conducted on 72 laboratory animals (52 white Wistar rats and 20 guinea
pigs) by the research team of INRMFB.
Results. After administration of the Covasna F3 mineral water, it was observed that the gastric secretion
volume remained unchanged, but the gastric juice pH values as well as total acidity decreased compared to
the control group, and gastric juice pepsin values were also lower following mineral water administration.
There was an increase in the activity of ATPase, a first-order energetic enzyme, and phosphatases, and a
reduction of transaminases and phospholipids in the liver homogenate. The metabolic-enzymatic function in
the hepatocyte affects choleresis, the bile secretion rate being dependent on hepatocytic metabolic processes;
an increase in the secreted bile amount was observed in the group of animals that received mineral water
compared to controls. The study of diuresis in rats reported an increase in the excreted urine amount, as well
as in uric acid and urea nitrogen excretion in animals that received mineral water compared to the control
group.
Conclusions. By analyzing the data obtained following this study regarding the pharmacodynamic action of
the Covasna F3 mineral water, it was found that it induces buffering of gastric secretion and an increase in
pepsin in the gastric mucosa, a rise in the excreted bile amount, in urine output, as well as in urinary uric acid
and urea nitrogen excretion.
L74
L75 - Very complex and difficult rehabilitation process in a post traumatic SCI complete tetraplegic
patient with intense and refractory spasticity and frequency of spasm with presacral pressure sores
(successfully operated)
Ali-Osman Saglam, Ana Carmen Albeşteanu, George Patraşcu,
Laura Popescu, Luminita Nirlu, Gelu Onose
Corresponding author: Ali-Osman Saglam, E-mail: aliosmansaglam1@gmail.com
1. “Bagdasar Arseni” Clinical Emergency Hospital, Bucharest

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest
Abstract.
Introduction.
Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which
occurs as a result of compulsion, incision or contusion. As a result of the injury, the functions performed by the
spinal cord are interrupted at the distal level of the injury. SCI causes serious disability among patients.
Material and method. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni”
Ethics Committee’s approval, a 48 years old patient, complete tetraplegic with intense and refractory spasticity
and frequency of spasm with presacral pressure sores (successfully operated) post traumatic SCI
The patient was functionally assessed using the following scales: : Glasgow Outcome Scale, Modified Rankin
Scale, Modified Ashworth, Penn Spasm Frequency Scale Functional Independence Measure, FAC International
Scale, Quality of Life Assessment.
The complex neurological rehabilitation and nursing treatment, together with medical treatment, psychiatric
and psychological evaluation and counseling, led to a favourable evolution.
Conclusions. Spasticity is a common secondary impairment after SCI characterized by hypertonus, increased
intermittent or sustained involuntary somatic reflexes (hyperreflexia), clonus and painful muscle spasms. Severe
spasticity may contribute to increased functional impairment, contractures, ulcers, posture disorders and pain.
Treatment should start as soon as possible to prevent such negative effects
Key words. paraplegia, sci, spasticity, pressure sores, traumatism
L75
L76 - Rehabilitation and Clinical-Evolutive Aspects in a Case of Paraplegia after Multilevel
Lumbar Disc Herniation, Spinal Canal Stenosis and Spondylolisthesis Iteratively Operated, in
a Pluripathological Context
Mihaela MANDU1, Elena CONSTANTIN1, Cristinel Dumitru BADIU1,2, Alina BAJENARU1,

Alexandru STAVRICA1, Cristina CIMPEANU1, Gelu ONOSE1,2
Corresponding author: Mihaela MANDU, E-mail: mihaelamandu37@yahoo.com
1. Teaching Emergency Hospital Bagdasar Arseni (THEBA), Bucharest, Romania

2. University of Medicine and Pharmacy Carol Davila (UMPCD), Bucharest, Romania
Abstract
Introduction. Disc herniation occurs most commonly in the lumbar region (95-98% of the cases). The current
trend is to have surgery on patients with disc herniation if the kinetic treatment was not beneficial. The data
from the literature suggest that early active recovery after lumbar disc herniation is more beneficial than a
traditional, less active training program.
Material and methods. Having the patient's consent and the approval of the Ethics Committee of “Bagdasar-
Arseni” Clinical Emergency Hospital, N.O. 17464 / 14.06.2019, the paper presents the case of a 75-year-old
paraplegic patient after multilevel lumbar disc herniation, spinal canal stenosis and spondylolisthesis
iteratively operated, in pluripathological context (hyperplastic type II obesity, hypertension, prostate
adenocarcinoma operated in 2015, Clostridium enterocolitis).
The patient was clinically and functionally evaluated, according to the standardized protocols implemented in
our clinic, through the assessment scales (ASIA, FIM, FAC, QoL, Asworth and Penn) and also para-clinically,
in order to evaluate his biological reserve and his bearing availability of the recovery program.
Results. The patient presented a slowly favorable evolution (slowed down not only by his multiple above-
mentioned comorbidities) from a dysfunctional point of view.
Conclusions. Early active recovery after lumbar disc herniation surgery is more beneficial than a traditional,
less active training program for operated herniated discs.
L76
L77 - Ais-C Paraplegia Caused by Cervico-Thoracic Spinal Epidural Hematoma and Thoracic
Subdural Hematoma – Clinical, Etiological (Mandatory Permanent Anticoagulant Therapy) and
Physio-pathological Particularities
Gelu ONOSE 1,2, Alina-Oana BĂJENARU1, Cristina CÎMPEANU1, Mihaela MANDU1,

Andreea DUMITRASCU1, Iulia-Maria NOHAI1, Daniel Costel SERBAN1
Corresponding author: Alina-Oana BĂJENARU, E-mail: alina.bajenaru@ymail.com

Abstract
Introduction. Almost all of the spinal hematomas are discovered in the epidural space, in contrast with
subdural hematomas, which constitute about 4.1% of all intraspinal hematomas.
The etiology of spinal hematomas includes vascular malformations of the spinal cord, an inadequate
anticoagulant and/or antiplatelet treatment, inherited or acquired disorders of coagulation, intense Valsalva
maneuvers, inflammatory myelitis, spinal cord tumors, abscess, idiopathic causes.
Material and methods. In this paper, approved by the Bioethical Committee of TEHBA
(no3159/30.01.2020), we report a 64-years-old female, chronically anticoagulated with a vitamin K antagonist
(acenocumarol) for a St Jude Medical aortic valve, presenting initially with thoracic pain followed by
progressive paraparesis (AIS-C) and further neurogenic bladder, diagnosed with both an cervico-thoracic
epidural hematoma and a thoracic subdural hematoma on the magnetic resonance imaging (MRI) who was
treated conservatively and experienced significant neurologic improvement.
Results. The MRI revealed a complete resorption of the cervico-thoracic epidural hematoma and a reduction
of the thoracic subdural hematoma, which corresponded with a favorable neurological outcome.
Conclusions. In spite of the fact that surgical decompression and evacuation of the hematoma is the first-line
treatment of the spinal hematomas, our patient showed consistent imagistic resolution and earlier neurological
improvement thus the non-surgical alternative was chosen. However, her clinical and functional improvement
must be both further monitored and approached thus entailing a continuously fine tuning of the anticoagulant
doses and the rehabilitation.
L77
L78 - Topical Systematic and Synthetic Literature Review Regarding Men Sexual
Dysfunctions After Spinal Cord Injury
Diana-Elena SERBAN1, Cristina Octaviana DAIA1,3, Ioana NEGOESCU CHEREGI2, Vlad

CIOBANU4, Liliana ONOSE5, Gelu ONOSE1,3
Corresponding author Diana-Elena SERBAN, E-mail: diana90elena@gmail.com
1.Teaching Emergency Clinical Hospital “Bagdasar Arseni”, in Bucharest, Romania

2.Teaching Medical Rehabilitation Hospital in Baile Felix, Romania
3.University of Medicine and Pharmacy “Carol Davila”, in Bucharest, Romania
4.Computer Science Department, Politehnica University of Bucharest, Bucharest, Romania
5.Medical Service – Metrorex SA in Bucharest, Romania
Abstract
Introduction. Spinal cord injury (SCI) is a life-altering event usually associated with loss of motor and
sensory, as well as with bladder, bowel and sexual, functions impairment – severely lowering the quality of
life. After the acute stage of injury, recovering sexual function is important, especially because most of such
patients are young and hence, previous to SCI, sexually active. Consequently, approaches of the pathology
domain we focus according to the title above, are necessary. In this respect, in the related literature can be
found data regarding mainly: diagnosis/evaluation issues therapeutic/assistive-rehabilitative interventions
(including connected to fertility troubles) and of psychological and or educational specific counseling, kind.
Materials and methods. This paper presents a current systematic (of Preferred Reporting Items for Systematic
Reviews and Meta-Analyses – PRISMA – type) and synthetic literature review on sexual dysfunctions and
respected available management options in male subjects with SCI, using the following search keywords/
combinations of key words: “men”, “sexual dysfunction”/ “fertility” / “erectile dysfunction”/ “ejaculatory
problems” / “sexual disorder“, “spinal cord injury”, “paraplegia”/ ”tetraplegia” /“paraplegic”/ ”tetraplegic”,
“management”/ “treatment”, by interrogating international renown data bases: NCBI/PubMed, NCBI/PMC,
Elsevier, PEDro and respectively, ISI Web of Knowledge/Science – to check whether the selected articles are
published in ISI indexed journals – considering publications from January 2009 to June 2019, written in
English, open access articles and being “fair”/“high” quality on our PEDro inspired, customized quality
classification of the selected papers – the basic criterion, being the weighted citations number per year.
Results. We have found initially 647 articles and eventually, after accomplishing the PRISMA stages (without
meta-analysis), we have selected 16 articles matching all the above mentioned quest method’s requests,
covering (together with knowledge acquired from extra bibliographic resources, too) the main sexual subject
matters men living with SCI are facing: erectile dysfunction (ED), ejaculatory and/or fertility problems, and
consequent (dis)satisfaction and respectively, the principal current methods to mitigate the respective
impairments, including with appropriate coping strategies.
Conclusions. Sexual disfunctions after SCI are complex and strongly add to the severe and multimodal
disability the affected people – in the case of our work: men – experience. Therefore, they worth being
fathomed and periodically reappraised.
Key words: Spinal Cord injury (SCI), men sexual dysfunctions, systematic literature review
Selected references:
1. https://www.ncbi.nlm.nih.gov
2. https://www.elsevier.com/
3. http://search.pedro.org.au/search
4. https://apps.webofknowledge.com
5. http://prisma-statement.org/documents/PRISMA%202009%20flow%20diagram.pdf
6. Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application.
J Spinal Cord Med. 2012;35(4):211–218. doi:10.1179/2045772312Y.0000000025
7. Ibrahim E, Brackett NL, Lynne CM. Advances in the management of infertility in men with spinal cord injury. Asian J Androl.
2016;18(3):382–390. doi:10.4103/1008-682X.178851
L78
L79 - A Complex Case of Neuro-Muscular Rehabilitation with Favorable Evolution, in a Patient
with Incomplete Tetraplegia Post Cervical and Thoracic Traumatic Spinal Cord Injury -
Surgically Treated, in a Polytrauma Context, By Car Accident
Andreea DUMITRAȘCU1, Ioana ANDONE MD1,2, Aura SPÎNU1, Carmen CHIPĂRUȘ1, Cristina
POPESCU1, Iulia NOHAI1, Magdalena LAPADAT1, Gelu ONOSE1,2
Corresponding author: Andreea DUMITRAȘCU, E-mail: dumitrascu.andreea0417@gmail.com

Abstract
Introduction. Spinal cord injuries (SCI) are major conditions that usually determine severe and permanent
dysfunctions, or even important loss of basic functions, generating severe or rather permanent sequels. They
can have important chronic consequences such as: tetraplegia or paraplegia.
Material and methods. In this paper approved by the Bioethical Committee of TEHBA (no3159/30.01.2020),
we present the case of a young 19-year-old patient who suffered in March 2019, a car accident (passenger)
with spinal cord injury (SCI) at cervical and thoracic level in a polytraumatic context, hospitalized at the
Neurosurgery Clinic (NS) II of TEHBA in a severe condition, for complete AIS/Frankel A tetraplegia, with a
C7 fracture, T3, T4, T5 cominutive fractures with fragments in the medullary channel, minor traumatic brain
injury, multiple costal fractures, abdominal trauma and respiratory failure. When the patient became
hemodynamic and respiratory stable it was decided a neuro-surgical intervention initially at cervical level
through an anterior approach, with mixed osteo-synthesis and C7 discectomy. Because of the spine instability,
thoracic surgical treatment was delayed with 11 days, when he suffers a neurosurgery for medullary
decompression, drainage and stabilization of the spine.
In our clinical division, the patient was admitted with an incomplete AIS/Frankel B tetraplegia and initially
followed a rehabilitation nursing program and subsequently continued with a recovery therapy according to
clinical stages. The patient was assessed functionally using the following scales: AIS/Frankel, modified
Ashworth, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International
Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord
Injury (WISCI).
Results. The patient benefited from a complex neuromuscular rehabilitation program, having a favorable
evolution, with an increase in the evaluated scales scores – passing from AIS/Frankel B classification to a
severe AIS/Frankel C stage, and thus, at the moment he is performing walking on short distances, through
parallel bars, with long left leg orthosis and support from another person. It was tried a sphincter re-education,
but, after a urologic examination, because of the important spasticity in the lower limbs and of the urinary
catheterization discomfort, it was decided that for a while the patient to remain with fixed urinary
catheterization.
Conclusions. Even if there is still no cure for SCI sequels, the accurate clinical-functional evaluation, the
neurosurgical prompt therapeutic approach, adding complex nursing measures, personalized rehabilitative
kinetological programs, in a young patient with SCI by car accident, determined neuro-locomotor
improvements with an increase in patient’s quality of life.
Bibliography:
1. Onose G., Anghelescu A., Ghid de diagnostic, tratament şi reabilitare în suferinţe după traumatisme vertebro-
medulare, Editura Universitară “Carol Davila” Bucureşti, 2011
2. Lin Vernon W, Cardenas Diana D, et al. Spinal Cord Medicine: principles and practice- Demos Medical Publishing,
Inc., New York, 2003
L79
L80 - CURRENT OVERVIEW REGARDING cLOSTRIDIUM DIFFICILE ENTEROCOLITIS IN a
NEURODISABLED INpATIENT AND a SYSTEMATIC LITERATURE REVIEW AND THE
EFFICACITY OF THE RELATED TREATMENT WITH IMMUNOGLOBULIN Y
Mihaela MANDU1, Cristinel Dumitru BADIU1,2, Gelu ONOSE1,2
Corresponding author: Mihaela Mandu, E-mail: mihaelamandu37@yahoo.com

1. “Bagdasar Arseni” Clinical Emergency Hospital, Bucharest
2. “Carol Davila” University of Medicine and Pharmacy, Bucharest
Abstract.
INTRODUCTION
Enterocolitis with Clostridium difficile represents a disturbance of the normal microbial flora of the colon.
Clostridium difficile infections occur most commonly in hospitalized patients, with antibiotic therapy being a
common factor that changes the beneficial bacterial flora. The incidence of enterocolitis with Clostridium
difficile has increased in recent years, especially in immunocompromised patients or those with Neurological
Disabilities. Immunotherapy targeting bacterial toxins is gaining interest at the expense of conventional
antibiotic therapy. Immunoglobulin Y is obtained from the yolk of eggs harvested from hens immunized with
Clostridium difficile antigen.
MATERIAL AND METHODS
By extending the literature review on enterocolitis with Clostridium difficile on the one hand and, by analyzing
the action of immunoglobulin, antibacterial and immune stimulating/ modulating actions, and also by looking
into the systematic literature review on the factors on the specific intervention (Immunoglobulin Y) on the
targets’ pathology (Clostridium enterocolitis) on the other hand, we have come to the conclusion that there are
very few papers with such specifications.
THE RESULTS OF THE LITERATURE REVIEW
It seems that the administration of Immunoglobulin Y therapy has been efficient in Clostridium enterocolitis
so far, thus preventing the relapse of the disease. Immunotherapy has gained interest as a non-antibiotic
alternative for the treatment of infectious diseases, including the infection with Clostridium difficile.
CONCLUSIONS: The results of the literature review show that there are not enough studies on the efficacy
of the immunoglobulin Y treatment in patients with Clostridium difficile enterocolitis. Therefore, this
literature review will be used as the basis of future applied research.
KEYWORDS: immunoglobulin y, clostridium, enterocolitis, Neuro-disability
L80
L81 - Fuzzy Regression Models as Model of Relationship among Variables, a Prospective Analysis for
Applications in Kinetotherapy
Dragos Arotaritei1, Iustina Condurache1, Marius Turnea1*, Catalin Ionite1, Mariana Rotariu1
Corresponding author: Marius Turnea, E-mail: tmarius_ro@yahoo.com

1. University of Medicine and Pharmacy „Grigore T. Popa”, Street University, No. 16, Iași, România
Abstract.
Introduction
Linear regression is practically the most used way to show relationship among variables in kinetotheraphy and
sports medicine. This relationship shows a linear connection among variables. It is worth to mention beside
the generalized linear models (GLM) there are many nonlinear models: Michaelis–Menten model for enzyme
kinetics, polynomial, multinomial, response surface methods (first, second and third order) abs so one. Many
nonlinear problems can be linearized moving the domain in a linear one by a suitable transformation, e.g.
logarithm function. The experimental data are not fit perfectly on the regression curve. There are always clouds
of points that are distributed around the curve that is there are we discuss about the most probable curve
according to some criteria of fitting (the minimization of least mean square – LMS, e.g.).
Materials and methods:

Fuzzy systems offer a theoretical and practical support to deal with vaguely determined variables. Much more,
this theory offers the possibility to infer linear or nonlinear relationship among categorical data. Fuzzy
numbers are fuzzy set that show a particularly shape (triangular, trapezoidal, Gaussian, Cauchy, etc.) with
extended arithmetic fuzzy operators (fuzzy sum, fuzzy difference fuzzy product, fuzzy division) in fuzz
framework.
Results
The experimental results are made on a practical application related to skin absorption and. The results showed
a good fit of data with the mathematical formula with an probabilistic view that include the most probable
curve along with possibilistic other curves close each of them having a certain degree of truth.
Conclusions
Alternative crisp approach in regression analysis, the fuzzy regression offers a larger perspective over
relationship among crisp/fuzzy variables along with categorical variables quantified in fuzzy numbers. More
application can be developed using this proposed techniques and solution can include all the points except the
outliers.
Key words: fuzzy regression model, fuzzy sets, mathematical models, mathematical relationship,
kinetotherapy.
L81
L82 - Case Presentation of a Patient with an Onset of Psychotic Disorder, Polytraumatized by
Defenestration From 10th Floor, with Thoraco-Lumbar SCI, And Multiple Somatic Fractures,
with Favorable Neuro-Motor and Psychiatric Evolution
Iulia-Maria NOHAI1, Andreea DUMITRASCU1, Alina Oana BAJENARU1,Cristina CIMPEANU1,
Simona-Isabelle STOICA1,2, Ioana ANDONE1,2, Carmen CHIPARUS1,Gelu ONOSE1,2
Corresponding author: Iulia-Maria NOHAI, E-mail: nohai.n83@gmail.com
Abstract
Introduction. Traumatic fractures of the spine are most common at the thoracolumbar junction and can be a
source of great disability. Most of them occur due to motor vehicle injuries and falls from a height. Since these
are high-velocity injuries, thoracolumbar fractures are commonly associated with other injuries like rib
fractures, pneumo-hemothorax, and rarely great vessel injuries, hemopericardium and diaphragmatic rupture
Materials and methods. Having the patient and the THEBA Bioethics Committee approval (no.
3159/30.01.2020), we will present the case of a 26-year-old patient who suffered a polytrauma due to
defenestration from the 10th floor - about 30 m high -resulted in thoraco-lumbar SCI, associated with other
severe injuries, hospitalized in Neuromuscular Recovery Ward by transfer from the Neurosurgery Ward of
our hospital, for neuromotor recovery, presenting a L1 AIS/ Frankel Quadriplegia and neurogenic bladder.
During hospitalization, the patient presented psychomotor agitation, food and medication rejection, which is
why repeated psychiatric evaluations were requested and performed.
Following the rehabilitation program, the patient's evolution was favorable: recovered the weight deficit,
improved the motor control and sensitivity, the urethral indwelling catheter was suppressed and the
intermittent catheterization program was started with later regaining of the micturition control.
The patient was assessed functionally using the following scales: AIS / Frankel, modified Ashworth,
Functional Independence Assessment (FIM), Life Quality Assessment (QOL), FAC International Scale,
Independence Assessment Scale in Daily Activities (ADL / IADL).
Results. The patient benefited from a complex program of neuromuscular rehabilitation, with a favorable
evolution, with the increasing scores from the evaluated scales and, thus, with a final performance of walking
with support on short distances, as well as a sphincter reeducation with the neurogenic bladder remission.
Conclusions. Associating interdisciplinary approach with a customized rehabilitation program in a patient
with an onset of psychotic disorder, polytraumatized by defenestration from the 10th floor, with thoraco-
lumbar SCI and other severe injuries led to neuromotor and psychiatric improvements, and sphincter function
reeducation with an important improvement in patient's quality of life.
L82
L83 - DIFFICULT – BECAUSE OF THE MAIN DISEASE’S ETIOLOGY AND CONNECTED
COMORBIDITIES – BUT FAVOURABLE EVOLUTION IN A CASE OF TYPE B NEURINOMA OF
PONTACEREBELLAR ANGLE, PARTIALLY REMOVED NEUROSURGICALLY -CASE REPORT
Ana Carmen REBEDEA 1 Laura Georgiana POPESCU1, Luminița NIRLU1, Ali OSMAN SAGLAM1 ,
Gelu ONOSE 1,2
Corresponding author: Ana Carmen REBEDEA, E-mail: ana.albesteanu@gmail.com
1
Teaching Emergency Hospital „Bagdasar-Arseni” Bucharest (TEHBA)
2
University of Medicine and Pharmacy “Carol Davila” in Bucharest, Romania
Abstract.
Introduction
A schwannoma, or a type B neurinoma, is a type of nerve tumor of the nerve sheath. It's the most common
type of benign peripheral nerve tumor in adults. It can occur anywhere in the body, at any age. A schwannoma
typically comes from a single bundle (fascicle) within the main nerve and displaces the rest of the nerve. When
a schwannoma grows larger, more fascicles are affected, making removal more difficult. In general, a
schwannoma grows slowly. 1

Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee
N.O 34136 from 18.11.2019, the current case report presents the case of a 30-year-old patient, diagnosed with
type B neurinoma- partially removed neurosurgically. He was admitted in our Neuromuscular Clinic Division
with the following health problems: spastic quadriplegia, expressive aphasia, dysphasia, amaurosis in the right
eye, sixth cranial nerve paralysis on both sides, neurogenic bladder, hearing impairments and respiratory
insufficiency. During his admission, the patient also developed keratoconjunctivitis in the right eye, an anxiety
disorder, a urinary tract infection, and severe pulmonary infection.
He was admitted into our clinic for the quadriplegic motor deficit, dysphagia, and aphasia, severe locomotor
and self-grooming dysfunction.
Results
The patient improved on most of the assessment scales/scores implemented in our Clinic’s Division Motor
FIM (Functional Independence Measure) from 13/91 to 38/91, and Cognitive FIM from 14/35 to 20/35, FAC
(Functional Ambulation Categories) from 0/5 to 2/5. The most important improvement in our patient’s
evolution was his ability to start walking again.
Conclusions
Following a complex neuro-recovery program developed by a multidisciplinary team made of doctors,

kinesio-therapists, middle and allied health personnel, the patient had a very good evolution. At his last
discharge from our clinic, he could walk with unilateral support on a fixed stand and moderate support from
the kinesio-therapist.
1
https://www.mayoclinic.org/diseases-conditions/schwannoma/
L83
L84 - Prophylactic/therapeutic modalities in vertebral balance disorders in children aged 10-12
years
Elena Vizitiu1, Sînziana Călina Silișteanu1, 2, Mihai Constantinescu1
Corresponding author: Sinziana Silisteanu, E-mail: sinzi_silisteanu@yahoo.com

1, 2
"Stefan cel Mare" University of Suceava FEFS-DSDU, Railway Hospital Iasi - Specialty Ambulatory of Suceava
1
”Stefan cel Mare" University of Suceava
1
Kinetic therapist - "Stefan cel Mare" University of Suceava
Abstract.
Introduction. Vertebral balance disorders are a health problem for children in general, with long-term
consequences. Having in view that the number of new cases with this condition has increased, it is mandatory
to introduce health programs and it is useful to perform a screening for vertebral balance disorders by groups
of age (pre-puberty, puberty, teenage).
The objective of the study was to assess the functional status of the child aged 10-12 years and to elaborate
the prophylaxis/ treatment program. The purpose was to draw the attention on the prevalence of vertebral
balance disorders in young people, with possible consequences in adult age.
Material and method. The study was performed for a period of 1 year and included 86 children. After the
clinical, anthropometric and somatoscopic evaluation, the recovery plan was designed, as well as the
prophylaxis for certain cases. The purpose was to create the right posture reflex, to tone up the paravertebral
and abdominal muscles, to increase the joint mobility and to fight obesity. The kinetic program was performed
3 times/week, 30 minutes/session. All children participated in a therapeutic swimming session every week.
Results. It was found in the study group that over 51% were girls, around 30.23% of children were diagnosed
with scoliotic attitude, 44.19% with kyphotic attitude and about 25.58% had a normal postural attitude.
Conclusions. The used kinetotherapy program (on land and in water) showed the improvement of the general
alignment, the ability of focusing and the adaptation to the school activities. The existence of a
multidisciplinary team ensuring the recovery program is an effective method by which the beneficial results
can be obtained for the health condition of this age group.
L84
L85 - Seasonal and Circaseptan Variation of Stroke Occurrence
Dana Marieta FODOR1, Gabriela DOGARU1, Lăcrămioara PERJU-DUMBRAVĂ1
Corresponding author: Dana Marieta FODOR, E-mail: fodordana@yahoo.com
1“Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
Abstract
Introduction. Cerebrovascular events are not randomly distributed over time. In addition to the better known
circadian variation, the occurrence of different vascular pathologies, including stroke, describes infradian
rhythms such is the seasonal or circannual variation (related by climatic cyclic changes) and the circaseptan
or weekly variation (a conventional rhythm, not a terrestrial one).
Objectives. The aim of our study was to investigate whether stroke with its types follows a seasonal and a
circaseptan occurrence pattern in the Cluj-Napoca area.
Materials and methods. The stroke event data were collected from the patient records of a consecutive series
of 1083 patients admitted through the Emergency Room to the Neurology Departments I and II of the County
Hospital Cluj-Napoca, between 1 January 2012 and 31 December 2012. The diagnosis of ischemic stroke,
intracerebral hemorrhage and subarachnoid hemorrhage was confirmed by neurologic examination and
neuroimaging, according to updated WHO criteria. The onset time was assigned to one of the four seasons
and also to the corresponding day of the week. Statistical analysis was performed using Excel Microsoft.
Results. All three types of stroke showed a seasonal variation in their occurrence, with two peaks, one in the
winter and the second in the summer. The circaseptan variation of stroke onset also reveals two incidence
peaks, one over the weekend continuing through Monday and the other one in the middle of the week. Age,
sex and the type/subtype of stroke enhances one of these peaks.
Conclusions. The knowledge of the seasonal variation pattern of stroke occurrence could provide a basis for
preventive and therapeutic strategies in cerebrovascular pathology, such as prevention infectious and
inflammatory episodes during cold season and dehydration in the summer, also for changes in the lifestyle and
psychophysiological stress related by transition from weekend to workdays.
L85
L86 - CORRELATIONS BETWEEN PROFESSIONAL RISK FACTORS AND THE PAIN
AND THE DISABILITY OF THE UPPER LIMB AND LOWER BACK AT LABOR
INSPECTORS
Dorin-Gheorghe TRIFF
Corresponding author: Dorin-Gheorghe TRIFF, E-mail: triffdorin@gmail.com
Occupational medicine department
Emergency Hospital County of Baia Mare
Abstract.
Within the periodic medical control, the inspectors from a territorial labor inspectorate received, for voluntary
completion, a questionnaire that scored their perception on the professional risk factors. The form had
comprised the folowing individual characteristics of inspectors: body mass index(BMI), age, sex, number of
persons at home, number of children, duration of the daily commute, financial situation, communication at
home, number of hours spent daily at work, number of extra hours spent daily in the same domain of activity
as service. At the same time, the inspectors received, for voluntary completion, The Disabilities of the Arm,
Shoulder and Hand (DASH) Questionnaire and Roland Morris Low Back Pain and Disability
Questionnaire(RMQuestionnaire).
Results
Those who perceive the presence of neuropsychological stress at work have significantly increased: age (p =
0.021), the score on the RMQuestionnaire (p = 0.019) and BMI (p = 0.019).
Those who perceive the presence of osteo-muscular joint overload have significantly increased:
age (p = 0.013), the score on the RMQuestionnaire (p = 0.036), and also have significantly lower number of
persons at home (p = 0.027).
Compared to women, men have increased body mass index (p <0.001) and the perception of the presence of
physical effort at work (p = 0.025). Age correlates significantly with score on the DASH questionnaire (p =
0.001) RMQuestionnaire (p = 0.006). Body mass index is positively correlated with the perception of the
presence of increased physical effort at work (p = 0.021). The score on the DASH questionnaire correlates
positively with that on the RMQuestionnaire (p <0.001).
Conclusions
Those with high BMI consider that physical exertion is increased at work. Age correlates positively with
lumbar and upper limb algal symptoms. Higher Low-Back-Pain and Disability is associated with the higher
Disability of the upper limb.
L86
L87 - Relationships between Temporomandibular Disorders and Cervical Spine
Disorders: The Appropriate Physiotherapeutic Approach
M. D. Crăciun1
Corresponding author: M. D. Crăciun, E-mail: danielacr@usv.ro
1. Ştefan cel Mare University of Suceava, Romania
Abstract
Introduction. Between the orofacial area and the cervical spine there are neuroanatomical and
neurophysiological interconnections.
Material and methods. Thirty seven patients with temporomandibular and cervical symptoms formed the
experimental group and thirty five patients only temporomandibular symptoms formed the control group.
The temporomandibular evaluation aimed at the assessment of the orofacial pain, the range of motion and
the assessment of the masticatory muscles and cervical evaluation aimed at the assessment ranges of motion,
cervical disability and presence of painful palpation sites.
Results. The average values are higher in VAS scores at patients with temporomandibular disorders (TMD)
and cervical dysfunctions. Also, dysfunctional indices are higher at patients with cervical impairment. Most
parameters of the active field of cervical movement presented an improvement over time.
Conclusions. The most important approaches for TMD physiotherapy treatment is the modification of
craniocervical biomechanics and its effects to posture as an etiologic or perpetuating TMD factor.
L87
L88 - Management of vestibular disorders
Liviu Lazăr, Carmen Nistor Cseppentö, Florin Marcu, Felicia Cioară
Corresponding author: Liviu Lazăr, E-mail: lazarlv@yahoo.com
University of Oradea, Faculty of Medicine and Pharmacy,
Rehabilitation Clinical Hospital Felix Spa
Abstract.
Introduction:
Vestibular neuronitis and acute viral labyrinthitis, benign paroxysmal positional vertigo, Meniere’s disease,
perilymphatic fistula and acoustic neuroma can be same causes of vestibular and balance dysfunction.
The symptoms result from pathology within the vestibular system that reduces the patient’s ability to move
about his or her environment without imbalance and vertigo.
Material and methods:
Disruptions of balance, dizzines and vertigo have a negative impact an one’s ability to live independently and
to perform routines of daily life. Balance is actually a complicated funcion maintained by signals the brain
receives from muscles and joints, eyes and the inner ear.
A comprehensive assessment can identify the types of strategies a person uses to balance, gait abnormalities,
the integrity of musculoskeletal system, head/eye coordination and motion perception. After assessment, an
individualized exercise program is developed to reduce movement or positional dizziness and to improve
postural control and gaze stabilization. It is essential that same kind of physical activity be continued on an
angoing basis and become a life-long practice.
Results:
Physiatric management of patiens with vestibular disordes requires a coordinated multidisciplinary program
that includes training in compensation and therapeutic exercises. Habituation and adaptation to motion-
provoked symptoms occur by readjustment of vestibulospinal, cervicoocular, visuoocular and vestibuloocular
reflexes.
Patients may also be instructed in relaxation exercies to reduce fatique and muscle tension. Education is very
important to help patients anderstand the cause of their symptons and haw to manage them. Vestibular
rehabilitation utilizer a home exercise program that is performed daily.
In conclusion, management of vestibular disoders includes the treatment of underlying pathology along with
a vestibular rehabilitation program. The physiatrist should be familiar with these treatmens and techniques so
as to help reduce mobility and balance dysfunction.
L88
L89 - Clinical-Evolutive Particularities and the Main Multimodal Therapeutic Difficulties in a
Patient with Schizophrenia who Suffered a TSCI By Falling from Height (Affirmative Suicide
Attempt) - A Case Report
Mihaela MANDU1, Elena CONSTANTIN1, Cristinel Dumitru BADIU1,2, Alina BAJENARU1,
Alexandru STAVRICA1, Cristina CIMPEANU1, Gelu ONOSE1,2
Corresponding author: Mihaela MANDU, E-mail: mihaelamandu37@yahoo.com
Abstract
Introduction. Schizophrenia is a surprisingly common chronic psychiatric illness in the general population
affecting 1 in 100 people worldwide. Although the symptoms widely differ from one case to another,
schizophrenia is quite difficult to recognize because the patient can behave normally and appropriately in
different social situations. Studies in the literature highlight that the majority of the patients with SCI and pre-
existing schizophrenia have suffered accidents as a result of voluntary height adjustments. Also, 37.5% of the
suicide attempts with SCI are caused by schizophrenia and depression. The main difficulties encountered in
the recovery of these patients are the psychiatric manifestations. At the same time, the risk of suicide in patients
with schizophrenia after suffering from SCI is higher than those with SCI without schizophrenia. Therefore,
the recovery of the patients with SCI and schizophrenia is a complex process which requires the control of the
psychiatric symptoms. A multidisciplinary team is required for such a purpose.
Materials and methods. Having the patient's consent and approval of the Ethics Committee of “Bagdasar-
Arseni” Clinical Emergency Hospital, N.O. 3159/30.01.2020, the paper presents the case of a 23-year-old
female patient with AIS/ Frankel B flaccid paraplegia after TVML after falling from height (affirmative
through window-suicide attempt) operated on, in a polytraumatic context. The patient is known with
schizophrenia and she was being monitored by a psychiatrist at the time of the accident, but she voluntarily
discontinued treatment during that period. The patient was clinically and functionally evaluated, according to
the standardized protocols implemented in our clinic, through the assessment scales (ASIA, FIM, FAC, QoL,
Asworh and Penn) and also para-clinically, in order to evaluate her biological reserve and her bearing
availability of the recovery program.
Results. The patient presented a slowly favorable evolution (slowed down by her severe motor deficit, but
also by her psychiatric symptoms such as affective ability with depressive, negative behavior,
depersonalization).
Conclusions. The main difficulties encountered in the recovery of these patients are the psychiatric
manifestations. Therefore, the recovery of patients with SCI and schizophrenia is a complex process that first
requires the control of psychiatric symptoms. A multidisciplinary team is required for such a purpose.
Keywords: schizophrenia, spinal cord injury, fall of height
L89
L90 - Contribution of Factors in Regression Analyze with Application in
Kinetotherapy and Sports Medicine
Marius Turnea1, Arotaritei Dragos1*, Catalin Ionite1, Iustina Condurache1, Mariana Rotariu1
Corresponding author: Arotaritei Dragos, E-mail: dragos_aro@yahoo.com
1
University of Medicine and Pharmacy „Grigore T. Popa”, Street University, No. 16, Iași, România
Abstract.
Introduction
The most influential variables in regression analysis can suggest actions that can be made in order to improve
the results in kinetotheraphy, sport medicine and rehabilitation. Linear regression is practically the most used
ways to show relationship among variables in kinetotheraphy and sports medicine. This relationship shows a
linear connection among variables a connection of first order. Variants as RSM (response surface method) of
order two and three include nonlinear interactions among the variables. The constant parameters can moderate
or increase the contribution of variables at the final formula of predictor, and results of procedures numerically
quantified as variables can contribute to a better understand of process modeled by regression. The parameters
can be ranked taking into account their influence on process so that the kinetotherapeuts can prioritize their
action in the rehabilitation plan.
Materials and methods

The range of values for each independent variable and the dependent variable are taken into account. A special
case is taken into account when the linear relationship has a small parameter; in this case a normalization
procedure is required. The evaluation of contribution is made in percent from total outcome. In the case of
linear relationship the approach is relatively simple but in the case of nonlinear case the proposed method is
more complex and it is based on statistical random generators applied on the combination of variables spread
on the domain of definition of all the components. This method needs a dynamical approach different from
quasi-static one that can be applied in the linear case.
Results
The method is applied to three cases in presented in literature: two for linear case and one for nonlinear
regression of second order. The results showed a reasonable perspective to alleviate the recovering plan using
simple mathematical methods.
Conclusions
The proposed method can be a useful tool of work for kinetotheraphy, sport medicine and rehabilitation. The
cases on nonlinear relationship are rarely in literature, so this aspect must be investigated more deeply in the
future
Key words: linear regression analysis, mathematical model, response surface method, statistical analysis,
sportive performance.
L90
P1 - Traditional Chinese Medicine - Challenges and Prospects for Rehabilitation Medicine
Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Marina BULAI1, Viorica JURJIU1,

Sergiu PETROȘIȘIN1

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.P1 P Vol.11, No.3, September 2020 p: P1
1. State University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau,

Republic of Moldova, The Department of Medical Rehabilitation, Physical Medicine and Manual Therapy
Abstract
Introduction. In a constantly evolving competitive society, personal health is increasingly neglected due to
the fast pace of life, affected by exhausting work, unhealthy diet, and stressful lifestyle. But any man would
like to keep his health and that is why he is looking for the most appropriate way for himself. At present, there
are two medical doctrines: Western (rationalist), based on Socrates' thesis "Know thyself" and the Eastern one,
based on Confucius thesis "Create thyself". [1,5]
Materials and methods. Traditional Chinese medicine (MTC) is 5000 years old. With a huge data hoard, a
refined culture dedicated to health care and prolonging life, it includes Phyto-therapy (herbal medicine),
acupuncture, moxa therapy, pre-puncture, cupping therapy, massage (tui na), exercise (Qigong) and dietary
therapy, but is currently influenced by Western modern medicine. Traditional Chinese medicine is a
complement and not an alternative, which is based on a fundamental principle: the existence of the two
components of nature, Yin and Yang, opposite and yet complementary elements, the theory of the 5 elements
(water, fire, wood, earth, metal). ), the theory of internal energy (Qi). By performing TCM techniques, we aim
to restore a harmonious flow of Qi vital force through the body, thus allowing the body to heal in a natural
way. [4] Since the Zhou Dynasty (1046–771 BC), it is well known that: “the patient's prognosis can be
predicted by five smells, five sounds and five colors, accompanied by changes in the nine holes (two eyes,
two ears, two nostrils, mouth, urethra and anus) and nine organs (heart, liver, spleen, lungs, kidneys, stomach,
large intestine, small intestine, and bladder). ” So the diagnostic methods are purely external, including the
interview. of the patient, inspection, pulse examination, patient's tongue. [2] Physical medicine and
rehabilitation is a branch of medicine that is concerned with promoting physical and cognitive functioning,
activities (including behavior), participation (including quality of life) and changing personal and
environmental factors. Thus, she is responsible for the prevention, diagnosis, treatment and management of
the rehabilitation of people with disabling conditions and co-morbidities at all ages. [3] We aim to combine
these techniques to achieve much better results and to find out what the prospects and challenges are.
Results. Traditional Chinese medicine used in rehabilitation can improve pain, increase muscle strength,
reduce spasticity, and harmonize the mental state of the patient associated with the disease.
Conclusions. The integration of academic science and traditional experience, of Western and Eastern visions
on maintaining and strengthening population health, prophylaxis, treatment, and recovery of diseases is very
important. MTC methods can be used as complementary methods in medical rehabilitation to increase
recovery performance.
Keywords: Traditional Chinese medicine, alternative treatment, rehabilitation
References:
1.LacustaV. Experiența internaținală de integrare a medicinii tradiționale și medicinii occidentlede, Buletinul Asociaţiei Medicină
Tradiţională din Republica Moldova. Chişinău, 2007. Vol. 12. p. 5-8.
2. Fundamentals of Traditional Chinese Medicine by Hong-zhou Wu, Zhao-qin Fang and Pan-ji Cheng (translated by Ye-bo He)
(Shanghai University of Traditional Chinese Medicine, China) ISBN: 978-1-938134-28-9 (pbk)
3.Ggidul de practică în specialitatea Recuperare (Reabilitare), Medicină Fizică şi Balneologie matie 2010
4.https://issuu.com/maria001234/docs/compendium de medicină tradițională
5.http://www.akademos.asm.md/files/Medicina%20alternativ%C4%83%20%E2%80%93%20integrarea%20cu%20medicina.pdf
P1
P2 - Intermediate Steps Towards the Achievement of an Official Romanian Translation of
The Fugl-Meyer Assessment Scale Specific Forms
Elena CONSTANTIN1, Mihaela MANDU1, Dumitru Cristinel BADIU1,2, Gelu ONOSE1,2
Corresponding author: Elena CONSTANTIN, E-mail: 13celena@gmail.com


Abstract
Introduction. The Fugl-Meyer assessment scale for the evaluation of neuro-sensory-motor deficits after
stroke represents, by completeness and adequate folding, both conceptually and methodologically, on the
physio pathological and clinical-evolutionary reality of disability in this type of pathology, a widely used
quantification tool for international level and well appreciated in many works in profile literature.
Materials and methods. From the desire to implement the scale within the neurorehabilitation units in our
country, some correspondence with the right holders of the use of the scale within the University of
Gothenburg was initiated in 2019. Subsequently, the group proposed us to carry out an official translation
according to an algorithm for achieving the unitary translation, agreed and recommended by the official
administrators of the standardized forms of the scale, which will be included on the official website of the
respective university along with other translations.
Results. Following the initial steps, a constructive correspondence was maintained with the official
administrators of the University of Gothenburg and in accordance with the mutual agreement, we carried out
the translation from English into Romanian of the specific forms on the official site. The translation included,
at the recommendation of the Gothenberg collective, only the component used for measuring the motor
functions for the upper and lower extremities. In addition, Prof. Dr. Roxana Carare was co-opted in the team
of. Currently, the confrontation of the translation version of our team with the one made by her (forward from
English to Romanian) is underway. Within the confrontation of forward translation, different shades of
formulations were found at different levels.
Conclusions. In the later stages, the reverse confrontation from Romanian to English (backward) of the two
translated variants is considered. At the same time, the coordinator of the administrators of the scale of the
University of Gothenburg, Prof. Dr. Margit Alt Murphy, expressed her availability of assistance at all stages
of the translation process.
References:
1.Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method
for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine. 1975 ;7(1):13-31.
2.https://www.sralab.org/rehabilitation-measures/fugl-meyer-assessment-motor-recovery-after-stroke
3.https://www.strokengine.ca/en/quick/fma_quick/
4.http://neurophys.gu.se/digitalAssets/1520/1520603_fma-ue-protocol-english-updated-20150311.pdf
P2
P3 - Treatment modulation with natural therapeutic factors from Techirghiol lake for the patients with
stroke, high blood pressure and diabetes
Stanciu Liliana-Elena1,2,*, Ionescu Elena-Valentina1,2, Chiriac Marius-Sorin1,2, Iliescu Madalina-

Gabriela1,2, Bobe Zoe-Maria1,2
Corresponding author: Stanciu Liliana-Elena, e-mail: lilianastanciu77@yahoo.com

1
2
Abstract.
Introduction. Natural therapeutic factors from Techirghiol lake area represents an important sector of balneal
treatments in our country, that’s why we try to demonstrate the major effects of these treatments over the
quality of life of the patients with combined stroke, high blood pressure and diabetes.
Matherial and methods. Our study group was selected from 1377 patients from Balneal Rehabilitation
Sanatorium of Techirghiol. 562 patients included in balneal specific treatments have been associated high
blood pressure, 26 of them were diagnosed with stroke, 80 with high blood pressure and diabetes type 2 and
19 patients with associated high blood pressure and stroke. Two of the patients were diagnosed with stroke
and diabetes type 2 and only one with all three : stroke, high blood pressure and diabetes.
Results. The data obtained by analysing the presence of high blood pressure, diabetes or stroke related with
age and gender of each patient from the study group demonstrates a direct correlation with these parameters.
The main scale of quality of life, such as Functional Independence Meassure (FIM), was influenced by the
therapeutical methods of treatment from sanatorium in this group of patients.
Conclusion. There is a treatment modulation using natural terapeutic factors from Techirghiol lake area in
patients with stroke and important comorbidities like high blood pressure and diabetes.
Key words: balneal, stroke, quality of life, Techirghiol
Refferences:
1. M.V. KAMENEVA, M.J. WATACH, H.S. BOROVETZ: Gender Difference in Rheologic Properties of
Blood and Risk of Cardiovascular Diseases. ClinHemorheolMicrocirc,21 (3-4), 357 (1999)
2. A.A. LUPU, E.V. IONESCU, M.G. ILIESCU, R.E. ALMASAN, C. OPREA, I. ION, D.M. ILIESCU:
Effect of Techirghiol specific climate factors on the patients quality of life with degenerative lumbar
pain.J Environ ProtEcol, 19 (4), 1857 (2018)
3. A. BARBULESCU, C. MAFTEI: Modeling the climate in the area of Techirghiol Lake (Romania),
Rom. Journ. Phys,60 (7-8), 1163, (2015)
4. VOS T., ABAJOBIR A.A., ABBAFATI C. et all - Global, regional, and national incidence, prevalence,
and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic
analysis for the Global Burden of Disease Study 2016 - The Lancet,390 (10100), 1211, (2017)
P3
P4 - Multidisciplinary Neurorehabilitation Approach in Children with Severe
Traumatic Brain Injury in „Dr Nicolae Robanescu” National Neurorehabilitation
Center For Children
Andra Pintilie¹, Liliana Pădure¹, Anca Grigoriu¹, Mihaela Axente, ¹
1. Pediatric Neuro-psycho-motor Rehabilitation National Teaching Centre “Dr. N. Robanescu”
Abstract
Introduction. Severe Traumatic Brain Injury (TBI) cases are a frequent pathology admitted in our center,
referred from the ICU /Neurosurgery Departament.
The approach of the TBI pathology in our hospital’s Rehabilitation unit consists in physicians (physical
medicine and rehabilitation, neurology, pediatrics, anesthesiology, psychiatry, endocrinology) and
therapists’ (physiotherapy, occupational therapy, speech and language therapy, electrotherapy) assessment.
The rehabilitation program includes examination, treatment and follow up, using human resources and
modern high technology with the purpose of achieving early standing, neurosensory stimulation, cognitive
stimulation, deglutition recovery and motor function recovery.
Materials and Methods. The rehabilitation program consists in modern tools of active and passive
stimulation of motor function, cognitive and neurosensory stimulation, spasticity decrement. An important
role in achieving the above mentioned is also played by ultrasound guided botulinum toxin intramuscular
administration.
After standing is obtained and the patient is able to perform autonomous walk, gait is evaluated through a
precise and objective assessment and follow up tool which is the gait analysis.
Results. The majority of the severe TBI cases (more than 80%) recover from the vegetative state, improving
the motor function and cognitive state, but most of them have secondary neurological impairment. 20-30 %
of cases have been fully recovered. 10-20 % develop post traumatic epilepsy.
Conclusions. Multidisciplinary approach is a key element in managing TBI patients with mild/severe
neurological impairment, and can only back up the nowadays results regarding improving the quality of life
of these patients, using human resources but also robotic rehabilitation devices.
P4
P5 Kinesitherapy Impact On Rehabilitative Outcomes In Spinal Muscular Atrophy
Nusinersen Treated Patients
A. Mirea1,2, L. Padure1,2, M.C. Leanca2, G.I. Marinescu2, B. Preda2, C. Sporea2, T. Spircu1,

G. Onose1,3

2. Teaching Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
3. National Clinical Centre for Children Neurorehabilitation “Dr. Nicolae Robanescu”, Bucharest, Romania
Abstract.
Introduction. Spinal muscular atrophy (SMA) is a degenerative disease with recessive autosomal
transmission, which affects motor neurons in the anterior cords’ corn (1), often
those in the brainstem, too, thus leading in time to their apoptosis with loss of muscle mass
and motor deficit. Taxonomically, there are five types of SMA: 0, I, II, III and IV (2). The first 4 have the
onset in the childhood, whereas type IV, usually starts in adulthood. It is important to apply, as soon as
possible, the medication dedicated to this disease - i.e. Nusinersenum (3), (acronymed) Zolgensma (4) and
standards of care which include, aside nutrition, respiratory management, psychotherapy, as a main therapeutic
kind of intervention: kinesitherapy. It is well known that this disease will lead to muscle retractions if the
patients are not correctly assessed and treat. It is important to use kinesitherapy, at least once a day, every day.
This will maintain muscle tonicity, combat stiffness and, together with specific pharmacotherapy, will help
improve motor status.
Methods. We included 37 SMA patients (aged 0-17 years): 12 with type I, 20 with type II and 5 with type III.
Every case was assessed 3 times (at the beginning of Nusinersen treatment, the 2nd time at 2 months after
Nusinersen initiation and the 3rd evaluation after 6 months since the first one). The patients with type I were
assessed on The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders - CHOP INTEND
(5) and the patients with type II and III were tested using Hammersmith Functional Motor Scale Extended -
HFMSE (6).
The primary data collected have been processed, using Microsoft Excel and SPSS v.24. There have been
calculated the effect size, then for type II and III we used Kolmogorov-Smirnov (7) test for populations’
normality T-test (8) and Mann-Whitney Test (9) for statistical analysis.
This study has been approved by the ethics’ commission of the NCCN “Dr. Nicolae Robanescu”, No 843/
29.01.2020.
Results. We found a statistically significant increase (p<0,001) of the above-mentioned scores in type II and
type III patients that had kinesitherapy every day, associated to the administration of Nusinersen during the
period that we observed, compared to those who received only Nusinersen.
In type I, because only one patient did not kinesitherapy, the statistical analysis available consisted of
percentual calculated effect size: increase ranging 4-21% (average effect size=13%) between the 1st and the
2nd assessment and ranging 15-55% (average effect size=31%) between the 1st and the 3rd evaluation in patients
who had associated kinesitherapy. The only patient who didn’t associate kinesitherapy had an effect size
increase of only 3% between the 1st and the 2nd assay and of 7% between the 1st and the 3rd evaluation.
The best motor functions improvement was observed in patients with type I, compared – difference statistically
significant (p=0,001) - to those with type II or type III (considered together for better statistical power), being
treated with Nusinersen and benefitting on kinesitherapy, too.
Conclusion. Physical therapy is very useful, associated with Nusinersen therapy, being thus an essential part
of SMA treatment.
P5
P6 - From Psychiatrist to Neurologist in the Outpatient at The National University
Hospital For Children Neurorehabilitation „Dr Nicolae Robanescu”
M.C. LEANCA1, C. ADAM1, L. PADURE1,2
Corresponding author: M.C. LEANCA, Email: mada_mada332@yahoo.com

Abstract
Introduction. In Romania, since 1996 child neuropsychiatry has been divided into pediatric neurology and
pediatric psychiatry so that there are two different medical specialties. Most of the outpatient children need
these two specialties so that in the National Center for Children Neurorehabilitation "Dr. Nicolae Robanescu"
there is a pediatric psychiatry office and also a pediatric neurology office.
Materials and methods. We will present cases that were initially addressed to the pediatric psychiatry office
with psychiatric disturbances (delay in language acquisition, hyperkinetic disorder, autism spectrum disorder,
depression). The psychiatrist sends these children to interdisciplinary consultation in pediatric neurology
because it is necessary to exclude a neurological cause of these psychiatric pathologies. We will also present
cases in which neurological pathology (cerebral palsy that associates comorbidities, the most common
epilepsy) is intricate with psychiatric symptoms and requires specialized evaluation.
Results. The patients sent by the psychiatrist had obvious epileptiform discharges and even a detailed history
of epileptic seizures, so antiepileptic treatment was also associated. Neurological patients with psychiatric
symptoms required antipsychotic medication and cognitive behavioral therapies.
Conclusions. The existence of the multidisciplinary team is necessary in order to make a correct diagnosis
and a permanent monitoring of the patients. In the ambulatory of our center there are specialized medical
doctor and modern equipment so that a complex intervention program is carried out to increase the quality of
patients' lives.
P6
P7 Exercise training compared to sedentary versus obstructive ventilatory dysfunction
patients
C.D. Nistro-Cseppento1, L. Lazar1, F. Cioară1, F. Marcu1, N. Pașcalău1, C. Bochiș2, D. C.

Iovanovici2
delia_cseppento@yahoo.com
1 Faculty of Medicine and Pharmacy Oradea,

2 The Faculty of Medicine V. Babes Timișoara
Abstract.
Introduction. Both sedentary lifestyles, through the complications it favors (muscle hypotrophy, obesity,
cardiovascular disease and diabetes), as well as respiratory diseases reduce the effort capacity, which we can
evaluate by the walking test, introduced in 1960 by Kenneth H. Cooper.
Material and method. We evaluated 20 patients, divided into 2 groups: 10 patients with chronic obstructive
bronchitis, stage II-III, respectively 10 sedentary patients, with degenerative pathology stage I-II who
underwent outpatient treatment in the Clinical Hospital "Avram Iancu" Oradea, for a period for 10 days. For
the evaluation of the exercise training we used the 6 minutes test and the Borg scale applied before and after
the treatment. They were measured: BP, HR, SaO2, distance traveled and degree of dyspnea. The patients
followed a recovery program, each 40 minutes / day, 10 days and as a method of increasing the training to the
effort we used the field treatment 4 km / h 30 minutes, daily.
Results. The mean age of the patients in the first group was 52.2 years, of the second group 54.3 years. The
average of the evaluated parameters are presented in the table below.
Conclusions. The average distance traveled by sedentary patients increases by 10%, and in the group with
COPD the distance increases by 8%.
Test at the beginning of the at the beginning of the At the end of the study, At the end of the study
study, before the 6 min study after the 6 min before the 6 min test after the 6 min test
test test
PARAMETER sedentary Patient sedentary Patient sedentary Patient sedentary Patient

with with with with
obstructive obstructive obstructive obstructive
ventilatory ventilatory ventilatory ventilatory
dysfunction dysfunction dysfunction dysfunction
BP 132/80 143/85 146/77 152/89 148/88 160/95 146/77 152/89
HR 68 78 75 90 68 78 75 90
Sa O2 95 93 92 91 95 93 92 91
Borg 4 5 5 7 4 7 3 6
321
P8 Current issues regarding the role of nutraceuticals in the management of osteoarthritis
Andreea-Raluca HANGAN, Gabriela DOGARU
“ Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca,

Clinical Rehabilitation Hospital Cluj-Napoca
Abstract.
Introduction: Arthrosis, also termed osteoarthritis, is the most prevalent form of arthritis, finally evolving
towards disability. The objectives of treatment in arthrosis are only partially met by the current therapeutic
armamentarium. Current medication does not have a disease-modifying effect and frequently generates
adverse effects that limit its therapeutic use, especially in the case of elderly patients, who have many
associated comorbidities. In this context, the interest of the public and of research has focused on a new
category of substances, isolated from foods, plants or animal products, which are aimed at meeting
pharmaceutical requirements, bringing the benefit of minimal side reactions.
Objectives: The aim of this presentation is to answer the question “What nutraceuticals have accumulated
scientific evidence regarding the treatment of patients with arthrosis?”
Material and method: The data were collected from the PubMed electronic database, and only recent articles
published after 2016, with scientific relevance to the aim of the paper were selected. The retrieved studies
provided information about the following nutraceuticals: avocado-soybean unsaponifiable extract, boswellic
acids, capsaicin, curcumin, ginger, polyphenols, polyunsaturated and monounsaturated fatty acids, black
cumin oil, cannabidiol, garlic, bromelain, devil’s claw, rosehip extract.
Results: The anti-inflammatory and antioxidant effect of the active substances extracted from foods and plants
largely explains their action on the decrease of the pain component and the improvement of functionality,
being similar to that of NSAIDs, but with a better safety profile. Regarding the disease-modifying effect, this
was found only in the case of the avocado-soybean unsaponifiable extract. The molecular targets on which
these compounds act begin to be known.
P8
P9 Functional electrical stimulation in patients with paraparesis
Bumbea Ana Maria, Borcan Madalina, Caimac Danut, Traistaru Rodica,
Rogoveanu Otilia
Corresponding author: Ana Maria Bumbea, E-mail: anamariabumbea@yahoo.com

Abstract.
Introduction
Functional electrical stimulation (FES) is a new acquisition in neurological disease with motor disabilities.
Material and method:
We included in study 5 patients with paraparesis determinate by different causes: spinal cord injury, multiple
sclerosis, and meningioma. The patients were evaluated functional by ASIA score and 6MWD initial and at
the end of the study. The patients included in our study started by level Frankel C. We applied FES in lower
limb for 30 minutes daily, in quadriceps and tibialis anterioris bilateral. The entire rehabilitation program was
for 14 days.
Results:
Patients that used this type of therapy improve their walking and standing and ASIA score increase with an
average of 10.3.
Conclusions:
This new therapy improves standing and gait in a shorter time compared with classical therapy applied in this
category of patients.
P9
P10 The revival of the traditions of health creative tourism in the
Dniester-Prut-Danube region
Anatolie BACIU2, Vasile FEDAŞ2, Ion MEREUŢA2, Constantin
IONESCU-TÎRGOVIŞTE1, Simona CARNICIU1
1-Prof Dr NC Paulescu National Institute of Diabetes, Nutrition andMetabolic Diseases, Bucharest, Romania
2-Institute of Physiology and Sanocreatology, Kishinev, Republic of Moldova;
Abstract.
Introduction
The main part of the circadian activity people spend their lives sitting indoors, surrounded by artificial
environment. Urbanization of settlements based on ultra-high density of buildings and traffic, the destruction
of the natural landscape, green spaces and ponds are implemented. The purpose consists of the development
of sanocreatoriums (centers for health creation, disease prevention and rehabilitation). The main objective of
practically implemented The Health Creation Program is to provide, as much as possible, a more diverse type
of training, rehabilitation and comfortable recreation.
Aerobic training (swimming in different styles, a set of exercises in water) is introduced into the planned set
of exercises. We strictly take into account the intensity of physical training sessions classified as moderate and
highly intense in accordance with their oxygen consumption indicators in relation to the maximum oxygen
consumption (70-80-90% VO2max). We tested the response of some groups of skeletal muscles to physical
exertion using the MES 9000 musculoskeletal testing system (Myotronics-Noromed Inc., USA). Pulse
oximetry (pulse oximeter PULSOX-300i, KONICA MINOLTA) was used as a non-invasive method for
monitoring the degree of saturation of arterial blood with oxygen.
Results*
The first principle elaborated for The Health Creation Program is to ensure free access to the natural landscape
enriched with greenery (forest, park) and endowed with the necessary infrastructure. We have outlined several
principles for improving the comfort and aesthetics of the rural zone. Architectural solutions based on the
design of houses built along the banks of the river. The second principle consists of systematic exercises
(physical, mental and emotional). The combination of aerobic with resistance anaerobic physical training and
proprioceptive exercises manifested an induction of tissue plasticity. Proprioceptive exercises performed in
the aquatic environment especially ensured the reduction of the gravitational load on the joints and facilitated
consolidation of sensory-motor integration.
P10
P11 - Stabilometry a Means of Evaluation and Treatment in Static Disorders in Children
- By Activating the Postural Tonic System
Mihai AVRAM1,2, Liliana PADURE1,2, Gelu ONOSE1,3

Corresponding author: Mihai AVRAM, E-mail: mihaiavram86@gmail.com

2. National Teaching Centre for Children Neuro-psycho-motor Rehabilitation “Dr. N. Robanescu”, Bucharest, Romania
3. Teaching Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
Abstract
Introduction. Static disorders in children are accentuated today for many reasons.
Materials and Methods. Through this study I have followed during 2 years 13 children between the ages of
5-13 years, in which we increased the evaluation and the clinical recovery through the intervention of the
stabilometry following the sensors of COP (center of pressure) and ROM (range of motion) that generated
real-time postural parameters - head deviation in the anterior-posterior and mid-lateral plane, trunk deviation
in the anterior-posterior and mid-lateral plane, COP deviation (pressure center) in the anterior-posterior and
mid-lateral plane. - as an assessment and recovery tool in spinal static deviations.
We performed anthropometric tests to quantify the results obtained before and at the end of the therapeutic
program: thoracic perimeter, thoracic elasticity, chin-sternum index, finger-soil distance, Cobb angle..
Results. All the children made the contribution of the recuperative apparatus intervention - following and
correcting the postural axis and maintaining it - obtaining the general isometry and a motor engram of the
corrected posture.
Conclusions. I learned that the child's participation - through awareness - in the correct posture, is much
improved when visualizing and following the vertical axis of the body.
The evolution of the parameters used in this study: it confirms the efficiency of the stabilometry in a percentage
of over 90%.
P11
P12 EVALUATION OF THE ANTINOCICEPTIVE AND ANTI-INFLAMMATORY
ACTIVITIES OF HESPERIDIN AND ITS INCLUSION COMPOUNDS IN MICE
Andreia Corciovă, Bianca Ivănescu, Daniela Carmen Ababei, Ana-Flavia Burlec,
Veronica Bild
Abstract.
Introduction
This study aims to evaluate the antinociceptive activity of hesperidin (HES) and its inclusion compounds with
beta-cyclodextrin (HES-βCD) and hydroxypropyl-beta-cyclodextrin (HES-HP-βCD) on inflammatory and
non-inflammatory nociception models, as well as the anti-inflammatory action.
For these experiments, we employed nociception models using thermal stimulus (hot plate and tail immersion
tests, t = 52.5 0C; 30, 60 and 90 minutes testing), chemical stimulus (Zymosan-induced abdominal constriction
response test, using distinct lots and testing at 60, 90 and 120 minutes after administration of samples) and
pressure stimulus (Randall Sellito test) and an inflammation model for the evaluation of inflammatory edema
by Plethysmometer test. Groups of 6-10 Swiss mice / lot were used, receiving by oral administration suspended
substances (HES and inclusion compounds) in 0.1% CMC-Na. The doses were administered in geometric
progression.
Results
HES showed antinociceptive and anti-inflammatory activities on all studied models for a 50 % activity level.
The analysis of the obtained ED50 values indicates a higher potency for the non-inflammatory nociception
models (using thermal stimulus) for the 90-minute test and a comparable potency between the inflammatory
nociception models and the inflammatory edema inhibition test.
The inclusion compounds presented different actions for the same activity level. HES-βCD has a higher
potency in thermal stimulation models at 60 minutes, comparable potency observed in inflammatory
nociception models and higher potency in the inflammatory edema inhibition test. HES-HP-βCD did not show
antinociceptive action on thermal stimulation models. The analysis of the ED50 values obtained in
inflammatory nociception models and in the inflammatory edema test demonstrates superior and comparable
potency.
Conclusions
The HES-βCD inclusion compound exhibited antinociceptive action predominantly on experimental non-
inflammatory nociception models, while HES-HP-βCD exhibited anti-inflammatory and antinociceptive
activities predominantly in inflammatory nociception models.
P12
P13 The role of personalized kinetic program in the recovery of post bimalleolar fracture of
the ankle
Iustina Condurache1, Catalin Ionite1, Mariana Rotariu1*

1
University of Medicine and Pharmacy „Grigore T. Popa”, Street Constantin Noica, Iași,
Abstract.
Introduction
The paper highlights the importance of customizing the kinetic recovery program used in the recovery of the
post-bimalleolar fracture of the ankle. During the research work, both the techniques used and the methods
applied to recover the functional balance are presented.
Material and method
During the study, thirtieth patients with bimalleolar fractures operated were monitored. They were evaluated
functionally post-operatively, during the recovery program and at the end of it. The recovery program was
made up composed of walking exercises focusing on the following parameters: walking, assisted walking,
walking with support, standing, climbing and descending the stairs, going up, down stairs.
Results
Both during the recovery program and at the end of it, different results were observed between the patients
monitored. Those who followed the initially established kinetic program, showed a better evolution compared
to those who did not exercise the recommended movements regularly.
Conclusions
Potential complications that may occur in the case of a bimalleolar fractures can be avoided after correct pre-
and post-operative evaluation and by using an individualized and personalized recovery method for each
patient's needs. Also, an essential condition is a good collaboration between the patient-physiotherapist-
orthopedic surgeon, so that complications and relapses can be avoided.
Keywords: ankle fracture, physiotherapeutic treatmen, evaluation
P13
P14 ORTHOPEDIC TREATMENT IN NEUROMUSCULAR SCOLIOOSIS
- CLINICAL CASE –
I.L. TIRIPA1, R. MANSOUR1, I. BRANEA1, I. GEORGESCU2,

M.C. LEANCA2, L. PADURE2,3, GELU ONOSE3,4, A. MIREA2,3
1. SRH Kilinkum, Karlsbad-Langensteinbach, Germany

Abstract.
Introduction. In neuromuscular disorders, as a result of muscle strength decrease, there is the risk of
developing scoliosis. Considering the impossibility of ensuring the correct and constant application of the
conservative treatment, the appearance and evolution of scoliosis are independent of it. Therefore, wearing a
corset will not prevent the development of neuromuscular scoliosis.
Material and Methods. A 14-year-old male patient was diagnosed with spinal muscular atrophy (SMA) type
II and had indications for wearing a corset. The patient's compliance with the conservative treatment and the
evolution of scoliosis in time were not monitored. Therefore, the surgical intervention was inefficiently timed.
Presented in our center with Cobb angle turaco-lumbar scoliosis more than 150 degrees, was rapidly oriented
to the department of spinal surgery with the indication of surgical correction.
In view of the comorbidities (SMA, respiratory insufficiency), the dorsal approach was chosen for spinal
correction. Given the collapsing spine, with marked vertebrae rotations, pelvic oblique and marked curvature
stiffness, the correction could only be partial.
The goal was not a complete correction, but basin horizontalization, restoration of an optimal sagittal profile,
balance of the column and body, respectively (and not least) the fusion.
Dorsal correction was performed with instrumentation from the T2 level to the ilium bone with posterior
spondylodesis and Ponte osteotomies in apex curvatures.
Results. Following the spinal surgery, performed in the clinic SRH Klinikum Karlsbad-Langensteinbach, the
patient regains his ability to sit independently, without external lateral support, thus contributing to improving
his quality of life and avoiding the accentuation of the restrictive respiratory insufficiency due to the marked
deformities.
Conclusion. In order to obtain best results, it is necessary to know the ideal moment for the application of all
therapeutic measures, including the surgical intervention. Patients must be carefully monitored for the most
indicated moment of scoliosis sanction..
P14
P15 Efficiency of botulinum toxin treatment in hemiplegic patient in upper limb, combined
with kinetotherapy
Borcan Madalina, Bumbea Ana Maria
Corresponding author: Ana Maria Bumbea, E-mail: anamariabumbea@yahoo.com

Abstract.
Introduction:
The high degree of spasticity causes a significant impairment of the functionality of the upper limb. In this
paper, our aim is to evaluate the efficacy of botulinum toxin therapy alone and in combination with
kinetotherapy on upper limb spasticity in stroke patients.
Material and methods:
Our study included 30 stroke patients, which we followed for a period of one year and were divided into two
equal batches. Patients in the first group benefited from botulinum toxin treatment at every three months, and
those in group two benefited from botulinum toxin therapy, a three-month administration combined with
kinetic therapy. All patients ranged in age from 50 to 70 years. All have undergone specific and appropriate
drug treatment. The evaluation was initially performed at the first administration of botulinum toxin, one week
after and every 3 months after the start of treatment, following the degree of spasticity according to the
modified Ashworth scale and Franchey scale.
Results:
Patients in the first group had a minimal reduction in spasticity by 15%, and those in the second group were
able to significantly improve, the status starting with a spasticity with a modified Ashwoth score of 3.8 and
reaching 2.8. The score on the Franchey scale showed significant improvements in group two, the first group
had a steady evolution in the first month, only at the last evaluation showed an improvement with an average
of 20%, compared to 35% as presented by group two.
Conclusions:
Botulin toxin therapy has proven useful in combating spasticity in the upper limb in post stroke patients. By
combining with the specific kinetic programs the improvement of the functional status proved on specific
scales is obtained.
P15
P16 - AICARDI GOUTIERES TYPE 2 SYNDROME
– SPASTIC CEREBRAL PALSY PHENOTYPE –
M.C. LEANCA1, L. PADURE1,2
Abstract.
Introduction.Aicardi-Goutières syndrome (AGS) is a rare genetic autoinflammatory disorder, affecting brain
and skin. Onset occurs within the ﬁrst few days or months of life with severe, subacute encephalopathy
(feeding problems, irritability and psychomotor regression or delay) associated with epilepsy, chilblain skin
lesions on the extremities and episodes of aseptic febrile illness.
Material and Method. We report a 3 years old female patient with normal pregnancy and delivery, normal
neuropsychomotor development who presented clear developmental regression after age of 11-12 months
when performed an cerebral MRI with sedation. He had subacute encephalopathy and loss of acquired skills
(no head control, no more sitting). The cerebral MRI shows extensive degeneration of white matter
hypomyelination with cerebral atrophy without basal ganglia involvement. Neurological examination shows
pyramidal signs (spasticity, brisk deep tendon and Babinski sign), axial hypotonia, extrapyramidal symptoms
(abnormal eye movement, dystonic postures of the upper limbs). After this episode the diagnosis of the patient
was spastic cerebral palsy.
Results: The investigation performed in this patient was leukodystrophy and leukoencephalopathy panel. The
results in this case were: RNASEH2B c.529G>A, p.(Ala177Thr) which is pathogenic. Biallelic pathogenic
variants in RNASEH2B gene cause autosomal recessive Aicardi Goutières syndrome type 2 (AGS2).
Conclusion: For the positive diagnosis in the case of cerebral palsy it is important to know the history of the
disease, the evolution (with regression in our case) and brain imaging findings. AGS2 involving the c.529G>A
allele is likely under-diagnosed and easily mistaken for spastic cerebral palsy. Early recognition influences
reproductive decisions and may allow for current and future therapeutic interventions targeting the damaging
effects of CNS autoinflammation.
P16
P17 - THE ASCENT AND DECLINE OF A GREAT BALNEOLOGICAL RESORT:
PUCIOASA
Doroteea Teoibas-Serban1, Liviu Iordache1, Dan Blendea1,2
Corresponding author: doroteeateoibas@yahoo.com

1. Clinical Regional Emergency Hospital Ilfov, Bucharest Romania

2. “Titu Mariorescu” University, Bucharest Romania
Abstract.
Introduction: Pucioasa is one of the greater and sadly, almost forgotten balneological resort of Romania.
Known since the 18th century, where it was discovered a record of this area on the Austrian map in 1791
with sulphurous streams, the healing waters of the “Pe Pucioasa” hill enters the therapeutic balneological
circle when the first water analysis occurred – 1821-1828 by Dr. Trangot von Schobel. In 1878, Ion Ghica, a
prominent figure in Romania at that time initiated the exploitation of 14 wells from the 30 known streams of
sulphurous and ferruginous waters, thus obtaining enough healing mineral water for a capacity of 60 beds of
the balneological establishment. Since 1841, the Resort developed, transformed into a Rehabilitation Clinic
(1969) and the number of patients treated there increased from 20 in the beginning to 1000 patient per day.
Many of the patients included foreign elite society members who came regularly to benefit from the waters’
healing properties, both external and internal cures, setting Pucioasa on a high level of not only balneology
treatment, but also of balneological tourism.
Matherials and methods: Studying local industrializations and water analysis, we concluded that there
were many factors that contributed to the decline of this great and international renowned balneological
resort. The first wrong step in this direction was made when building and extending de gypsum carrier, the
peek being between 1970 and 1975, when the industrial forging process made the sulphurous streams to
migrate, and the waters from the wells diminished in its sulphur and iron concentration. Another possible
factor for the decline can be the modernisation of the medical world, development of anti-inflammatory
drugs and modern medical equipment which reduced the need for the elite society to come a long distance
for the balneological treatment.
Results: Whichever of the reasons, the once prosperous Balneological Resort of Pucioasa fell into an
unknown, unimpressive place, known and frequented only by the locals. The Rehabilitation Clinic still has
60 beds, which are occupied to the maximum each month, it still prospers on a local level, but lost its glory
from almost a century ago.
Conclusions: The Romanian general population and the government must take an interest to one of the
many once prosperous balneological resorts in order to revive the national treasure of Romania which is
balneology, which many of the developed European countries only wish that they can possess.
P17
P18 - REHABILITATION LIMITATIONS ON POST-SURGERY KNEE AND HIP
PROSTESIS IN ELDERLY PATIENTS
Doroteea Teoibas-Serban1, Ioana Albu1, Anca Adam1, Iolanda Panaitiu1, Cezara Mihailov1,
Matei Rebecnouc1, Liviu, Iordache1, Dan Blendea1,2
Corresponding author: doroteeateoibas@yahoo.com
1. Clinical Regional Emergency Hospital Ilfov, Bucharest Romania

2. “Titu Mariorescu” University, Bucharest Romania
Abstract.
Introduction: Knee and hip surgery in elderly patients increased in the last years due to the Romanians’
Ministry of Health aiding programs. After the orthopaedic surgical treatment of these patients, the general
approach is to send them to the rehabilitation unit as soon as possible. Though rehabilitation procedures
specific for this type of pathology immediately post-surgery exist, there are some limitations in this process.
Materials and method: There are a number of things which a health-care provider must consider when
approaching prosthetic hip/knee elderly patients:
1. Elderly patients, especially females, in most of the cases have osteoporosis or osteopenia which can
delay the osteosynthesis process and thus, prolong the bedrest period.
2. Patients which are confined to bedrest or non-movement, must take anticoagulant treatment to prevent
thrombosis, they have post-surgery local inflammation and pain, and we can’t prescribe anti-
inflammatory medication due to risk of haemorrhage.
3. Contraindication to use physiotherapy to relieve pain because of the metallic material of the prosthesis.
4. The cardio-respiratory complications which can occur during the bedrest period in elderly patients.
5. The need to collaborate constantly with the orthopaedic surgeon to get multiple rehabilitation
recommendation document in order to have multiple hospital admissions for the same patient in a year
in order to make the patient gain complete motor function.
Results: Although kinesiotherapy made great progresses in the area of improving muscle strength and mass
although the patient is confined to bedrest, we have to admit that if the osteosynthesis process is prolonged,
the results are delayed and the window for complications to occur is wide opened.
Conclusions: We will continue this general list of limitations with a clinical trial, obtaining statistic results on
the majority of them in order to improve the rehabilitation process of these patients.
P18
P19 - THE IMPORTANCE OF PHYSIOTHERAPY IN COMA STAGE PATIENTS
Dora V. SZAKACS (POPOVICI)

E- Mail: popovici.dora@yahoo.com
" Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca
Abstract.
Introduction
Traumatic Brain Injury (TBI), is an important public health problem and leading cause of injury, death and
disability in worldwide. The TBI can cause long-term physical disability and the neurological impairments
such as motor function (coordination, balance, walking, hand function, speach) and sensory loss - are
important sequels that affect the quality of life.
Objectives
The physical therapy rehabilitation needs to identify these impairments and help the person to achive the
maximum degree of return to their previous level of functioning. Thus, the physiotherapist plays a central role
in leading, coordonating and providing a continuum of care and services over the course of the patient's
recovery. On the rehabilitation process, first the physiotherapist needs to identify the physical impairments
wich may be directly related to the brain injury or secondary to concomitant orthopedic or spinal cord injury.
Material and method
While people are ill in the intense care unit, they lose weight (almost 2% of their muscle mass per day during
their illness). This means muscles get weaker, which can result in severe physical disability. Rebuilding these
muscles takes time and in some cases can take more than a year. If people are imobile for some time, their
joints may became stiff. To help them recover muscle strenght, physiotherapists help them with exercises to
restore their mobility.
Physiotherapy is very important considering most of the patients from intensive care unit - the progress they
made daily with the support physiotherapists. This ranged from moving arms and legs, gripping, walking with
a Zimmer frame and crutches, taking their first step alone to being able to walk across the ward and , finally,
up and down stairs.
Conclusions
Physical exercise can help mantain or improve strenght in the muscles not affected by MND, and mantain
flexibility in muscles that are affected. It can help prevent stiffness in the joints. Physiotherapy may also help
people with difficulties to clear their chests and mantain lung capacity at a normal level.
Bibliography
Bratu,M.; " Communication and counseling in physiotherapy"; University Ed. Bucharest; Romania; 2013.
Dragan, C.F.; " Methodology and techniques of physiotherapy"; National Ed. Bucharest; Romania; 2018.
F. Plas; E.Hagron; " Active kinetic therapy. Therapeutic exercises"; Ed. Polirom; Bucharest; Romania; 2001.
Khan F.; Baguley IJ.; Cameron ID; " Rehabilitation after traumatic brain injury"; California; DOOR; 2003.
P19
P20 - The right anticoagulation drug for post-stroke patients.
Claudiu Elisei Tanase2, Sorina Mierlan2, Mădălina Codruța Verenca1,2

Corresponding author: Claudiu Elisei Tănase, E-mail: tanaseclaudiumd@gmail.com
1. Clinical Emergency Hospital for Children "Sf.Ioan" , Department Rehabilitation , Galati, Romania
2. "Dunarea de Jos” University, Galati, Romania
Abstract.
Introduction: Patients that suffered a stroke are subjects of rehabilitation in order to retrain to their own
maximal physical, psychological, social, and vocational potential, consistent with physiologic and
environmental limitations. The literature offers us the possibility to engage the patient in early intensive
exercise therapy even within 24 hours since the symptom unset. We as rehabilitation physicians have to take
under observation the right OAC drugs and the doses that are administered to the patient. Oral anticoagulation
can be frequently associated with anaemia, and if it is as a result of bleeding, due to the high dosage that
usually leads to reduction or a discontinuation of the treatment which will result in a high risk of a secondary
stroke or thrombo-embolism.
Methods: The study is an analytic and statistic one that followed the evolution of patients under treatment for
4 months, October 2019 – January 2020. We included patients that have had been treated for ischemic or
haemorrhagic stroke.
Results: The data that we procured as a result of the study, proved that we don’t have enough information to
be certain of the right OAC for patients after stroke. While the NOAC have better results there is still high risk
of anaemia due to chronic bleeding, or another ischemic stroke due to the low INR values.
Conclusion: OAC is a very important part of the rehabilitation for stroke patients. Even with the NOAC which
are supposed to be superior, we run the risk of a reoccurring stroke especially on patients who do not check
their INR values periodically, and the physicians attitude towards those values which may vary from reducing
the dosage to the discontinuation of the treatment because of scare of a internal bleeding. That resulting in
increasing the risk of a thromboembolism or ischemic stroke. The information at hand is not enough to draw
a conclusion but it should serve as a warning.
Key words: stroke, rehabilitation, OAC
P20
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Constantin MUNTEANU¹,², Diana Nicoleta MUNTEANU1,3, Gabriela DOGARU1,4

Corresponding author: Constantin MUNTEANU, E-mail: office@bioclima.ro

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L1 OP Vol.11, No.3, September 2020 p: L1

1. Romanian Association of Balneology, Bucharest, Romania

Gabriela DOGARU¹, Ioana STANESCU¹, Adriana BULBOACĂ¹, Marieta MOTRICALA²

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L2 OP Vol.11, No.3, September 2020 p: L2

VARODI Mariana¹ , DOGARU Gabriela²

Corresponding author: VARODI Mariana, email: nicovarodi_bft@yahoo.com

1.Ocna Sibiului Strand Spa Complex

GÁSPÁR Boróka-Panna¹, DOGARU Gabriela²

Corresponding author: GÁSPÁR Boróka-Panna, E-mail: g.boro@hotmail.com

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L4 OP Vol.11, No.3, September 2020 p: L4

1. “Prof. Dr. Ioan Puşcaş” City Hospital, Şimleu Silvaniei, Romania

Doina-Clementina Cojocaru, Paraschiva Postolache

Presenting author D.C.Cojocaru, E-mail: clementina.cojocaru@gmail.com

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L7 OP Vol.11, No.3, September 2020 p: L7

Anca Irina GRIGORIU1, Liliana PADURE 1,2

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L8 OP Vol.11, No.3, September 2020 p: L8

1. National Center of Rehabilitation for Children „Dr. N. Robanescu”, Bucharest, Romania

Ana Maria Bumbea

Otilia ROGOVEANU1, 2, Andra CRUCERU2, Cioroianu GEORGE2, Alesandra FLORESCU3,

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L10 OP Vol.11, No.3, September 2020 p:

Otilia ROGOVEANU, Andra CRUCERU, Cioroianu GEORGE, Alesandra FLORESCU,

Corresponding author: Otilia ROGOVEANU, E-mail: otilia.rogoveanu@gmail.com

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L11 OP Vol.11, No.3, September 2020 p:

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L12 OP Vol.11, No.3, September 2020 p:

Catalin Ionite1, Iustina Condurache1, Mariana Rotariu1*

Corresponding author Mariana Rotariu, E-mail address: rotariu29@yahoo.com

Keywords: scapulohumeral periarthritis, physiotherapeutic treatment, evaluation

Corresponding author Mariana Rotariu, E-mail address: rotariu29@yahoo.com

Keywords: acvatic activities, physical exercise, evaluations

Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Oleg PASCAL1, Ana – Maria BODEAN1

Corresponding author: Victoria CHIHAI, E-mail: victoria.chihai@usmf.md

Andreia Corciovă, Bianca Ivănescu, Daniela Carmen Ababei, Ana-Flavia Burlec,

Materials and Methods

Dragos Petrica SARDARU¹, Daniela MATEI¹

Corresponding author: Dragos Petrica Sardaru, E-mail address: serdarud@yahoo.com

Ana-Maria FĂTU1, Ana Maria PÂSLARU1, Valerica CREANGĂ-ZĂRNESCU1, Mădălina

Key words: dementia, stroke, risk factors, cognitive, decline

Mihaiela CHICU1,2, Carmen ANTON1

Corresponding author: Mihaiela CHICU, E-mail: mihaielabitere@yahoo.com

1. University of Medicine and Pharmacy U.M.F. “Gr.T. Popa” Iasi, Romania

Victoria CHIHAI1, Alisa TĂBÎRȚĂ1, Svetlana PLEȘCA1, Maxim LUPU1

Corresponding author: Victoria Chihai, E-mail: victoria.chihai@usmf.md

1. State University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau, Republic of Moldova

Corresponding author: Mihaiela CHICU, E-mail: mihaielabitere@yahoo.com

Keywords: endothelial dysfunction, ET-1, ET-2.

Corresponding author: Anisoara CIMIL, email: cimil.anisoara@gmail.com

1. ,,Nicolae Testemitanu,, University of Medicine and Pharmacy, Kishinev, Republic of Moldova

Corresponding author: Ana-Maria Fătu, E-mail: anafatu09@gmail.com

Material and method.

Results and discussions.

Key words: physical exercise, treatment, breast cancer

Dumitru MIHĂILĂ¹, Sinziana-Calina SILISTEANU ², Mihaela (Ciurlică) ȚICULEANU¹

Corresponding author: Sinziana-Calina SILISTEANU, E-mail: sinzi_silisteanu@yahoo.com

1. Geography Departement, USV, Romania

Introduction. Human health is dependent on the variability of meteorological factors, of meteorological

Keywords: musculoskeletal disorders, atmospheric factors, health status

Ilie Eva; Luca Mirela; Vasilescu Toma

Balneo Research Journal DOI: http://dx.doi.org/10.12680/balneo.2020.346.L25 OP Vol.11, No.3, September 2020 p:

Corresponding author: Liliana Elena Stanciu, E-mail: chiriacsorin2002@yahoo.co.uk

Keywords: mud, osteoporosis, balneal, hormones